module 1

A graduating nurse student is deciding which nursing specialty would be a good place to begin a nursing career and ensure long-term stability. Which specialty is most likely to have the greatest growth in need? 1. Pediatric nursing 2. Psychiatric nursing 3. Geriatric nursing 4. Maternity nursing

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The nurse managers expected outcome is to increase evidence-based practice on the nursing unit. To meet this outcome, the manager encourages nurses to base their practice on which technique? 1. Intuition 2. Personal clinical experience 3. Knowledge from nursing school 4. Current research

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To meet the Institute of Medicine (IOM) recommendation, nursing should strive to have ____ % of nurses prepared at the baccalaureate or higher level by 2020.

80

Question 19 Type: MCSA Which situation requires an adaptive decision? 1. The nurse manager discovers that two clients require the use of a new piece of equipment and that the one the hospital has is the only one in the state. 2. The nurse has made a medication error on an experimental medication. 3. The nursing student makes an error when changing a client dressing. 4. The nurse manager scheduled too many nurses for the client census on the night shift, and all of the nurses scheduled have already been asked to take a low-census unpaid day off this month.

Correct Answer: 1 Rationale 1: Adaptive decisions must be made when the situation is unusual and there is no clear-cut policy for decision making. Rationale 2: Making a medication error is not an unusual situation, and a policy exists for handling this issue. Rationale 3: A policy exists for handling procedure errors. Rationale 4: A policy exists for handling staffing errors.

The nurse administrator has been asked to work with other administrators to make a change in a long-standing hospital policy. What should be the nurses first action? 1. Research the options that will work best for the nursing staff and the hospital. 2. Speak positively of the change to ensure the most buy-in from the nurses. 3. Encourage the other administrators to choose the option that is easiest for the nurses. 4. Ensure that each nurse is aware of the change and why it is necessary.

Correct Answer: 1 Rationale 1: Assessment is always the first action for a nurse in any situation. Rationale 2: This constitutes an intervention and is not the first action. Rationale 3: This constitutes an intervention and is not the first action. Rationale 4: This constitutes an intervention and is not the first action.

Currently clients on a unit are bathed in the morning between 8:00 am and 11:00 am. The nursing staff is contemplating changing that routine to bathing clients in the evening between 7:00 pm and 9:00 pm. Which statement reflects an underlying assumption that might affect the staffs ability to think critically about this change? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The day shift just wants to shift work onto the evening shift. 2. Everyone likes to bathe right before bed. 3. I read a research article that reported that clients sleep better if they have been bathed right before bedtime. 4. The physician staff will be upset if we change our morning routine. 5. If we let them change this, they will want to make lots of other changes, too.

Correct Answer: 1,2,4,5 Rationale 1: This is an underlying assumption about why this change is being considered. Rationale 2: This speaker assumes that everyone likes to bathe right before bed, not taking into consideration that some like to bathe in the morning. Rationale 3: A research article report is not an assumption, but is based on evidence. Rationale 4: This is an assumption that might well be erroneous. Rationale 5: This is an assumption.

successful, these health care providers should ensure which resources are available? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Electronic medical records (EMR) technology 2. A sufficient number of older adults who require long-term care 3. An understanding of the complexity of multiple-need clients 4. A robust marketing plan that describes the homes physical environment 5. A plan for compensation for the primary care provided

Correct Answer: 1,3,5 Rationale 1: For medical homes to be most effective, EMR should be implemented. Rationale 2: A medical home is not the same as a long-term-care facility. Rationale 3: One of the challenges in developing a medical home is the multiple needs of clients who have chronic conditions. Rationale 4: The medical home is not a bricks-and-mortar facility. Rationale 5: Problems with electronic delivery of data and information and compensation for primary care are challenges associated with developing a medical home.

The administrators of a small hospital are revising its disaster plan. What should be the primary focus of this plan? 1. Preparing for a surge of casualties in case of a disaster 2. How to prevent disasters from occurring 3. How to fund disaster management 4. How to reduce disaster impact on clients and staff 5. How to identify risks for disasters

Correct Answer: 1,4 Rationale 1: One of the primary focuses of a disaster plan is how to care for the influx of clients. Rationale 2: Prevention of internal disasters is the focus of physical plant planning and safety planning. It is not the primary focus of the disaster plan. Rationale 3: Funding in a disaster is problematic. It is not possible to plan for the extent of the disaster or its impact on funding, or to predict who will pay. Rationale 4: There may be physical, mental, and emotional impact on clients and staff. Planning is a way to reduce this impact. Rationale 5: Risk identification is part of a safety plan.

Which statement indicates understanding of how a nurse could improve personal decision-making skills? 1. We should gather a group together to make important unit decisions to ensure fairness. 2. I should practice making decisions by developing potential solutions and then choosing one. 3. We can make a decision and then ask for input from others to make sure it was the right choice. 4. I know I will never be able to improve my decision-making skills because I am not a strong person.

Correct Answer: 2 Rationale 1: Depending on a group is not likely to help the nurse improve personal decision-making skills. Rationale 2: Practicing making decisions will increase the nurses experience, comfort, and overall skill. Rationale 3: Including a we in this process is not as likely to improve the nurses personal decision-making skills as making an individual decision. Asking for input to make certain the choice was correct indicates lack of certainty. Rationale 4: Decision-making skills can be learned regardless of ones perceived personal strength.

A proposed change in a health care organization is controversial and will require cooperation from all parties involved. Which change strategy should the change agent use? 1. Empirical-rational 2. Normative-reeducative 3. Power-coercive 4. Empirical-reeducative

Correct Answer: 2 Rationale 1: Empirical-rational strategy is used when little resistance to the proposed change is expected. Rationale 2: Normative-reeducative strategy uses collaboration as its primary decision-making technique. It is most likely to result in the greatest number of people being happy with the decisions made. Rationale 3: Power-coercive strategy is the least likely to result in everyone agreeing with the change. Rationale 4: This is not one of the change strategies.

What is the best example of a pediatric units organizational culture? 1. All client rooms are private. 2. Nurses wear colorful scrubs. 3. The nurse-to-client ratio is 4 to 1. 4. The primary nursing model is used for care.

Correct Answer: 2 Rationale 1: Organizational climate is based on physical attributes and policy and procedure. Private rooms are an example of organizational climate. Rationale 2: Organizational culture is based on norms and traditions such as nurses wearing colorful attire. Rationale 3: Organizational climate is based on physical attributes and policy and procedure. The nurse-to-client ratio is an example of organizational climate. Rationale 4: Organizational climate is based on physical attributes and policy and procedure. Using primary nursing models is an example of organizational climate.

Which situation reflects the primary service provided by home health care? 1. The physical therapy assistant performs range-of-motion exercises three times each week. 2. The nurse changes the clients abdominal dressing daily. 3. Oxygen is provided in the home and managed by a durable medical equipment company. 4. Diabetic testing supplies are delivered to the clients home each month.

Correct Answer: 2 Rationale 1: Physical therapy is an important aspect of home health care but is not the major service provided. Rationale 2: Nursing care is the primary service provided by home health agencies. Rationale 3: Provision of durable medical equipment is an important aspect of home health care but is not the primary service provided. Rationale 4: Provision of medical supplies is an important aspect of home health care but is not the primary service provided.

Question 23 Type: MCSA A newly promoted nurse manager is fearful that previous coworkers will undermine her efforts to succeed in this new position. The new manager does not share information with these coworkers even though they may need the information to understand changes that are going to occur in the organization. Which emotional intelligence self-management competency is this nurse most clearly violating? 1. Adaptability 2. Initiative 3. Transparency 4. Optimism

Correct Answer: 3 Rationale 1: Adaptability is flexibility in adapting to changing situations or overcoming obstacles. Rationale 2: Initiative is readiness to act and seize opportunities. Rationale 3: Transparency is displaying honesty, integrity, and trustworthiness. This nurse is not displaying these traits. Rationale 4: Optimism is seeing the upside in events.

The nurse manager has decided to use evidence-based practice (EBP) to solve an issue and has called staff nurses together for input. Which question, as posed by the manager, reflects the first step of the EBP process? 1. What outcomes are we expecting from this work? 2. Is anyone prepared to evaluate the statistics we will find? 3. What is the exact clinical issue with which we are dealing? 4. Where can we look for information?

Correct Answer: 3 Rationale 1: Assessing outcomes is the last step of the EBP process. Rationale 2: Evaluation of the evidence is step 3. Rationale 3: Identifying the clinical question is the first step in the EBP process. Rationale 4: Acquiring the evidence to answer the question is step 2.

We want to be the hospital of choice in the Midwest is which type of statement? 1. Value statement 2. Mission statement 3. Vision statement 4. Philosophy statement

Correct Answer: 3 Rationale 1: The value statement concerns the beliefs or attitudes esteemed by the organizations leaders. Rationale 2: The mission statement is a broad statement of the organizations reason for existence. An example is Our mission is to improve the health of the people of the Midwest. Rationale 3: A vision statement describes the goal to which the organization aspiresin this case, to be the hospital of choice in the Midwest. Rationale 4: A philosophy statement reflects the organizations values, vision, and mission, so it is all-inclusive.

A nurse is working in a unit with several less-experienced nurses. Which attribute displayed by the senior nurse would make her leadership of the less-experienced nurses most effective? 1. Strong belief that the leader is accountable for actions taken by those working on the unit 2. Authority to carry out actions necessary to move the work of unit staff forward 3. Efficiency in actions and in words 4. Ability to inspire the others to commit to the teams goals

Correct Answer: 4 Rationale 1: A leader may have no formal accountability or authority. The manager has that authority. Rationale 2: The unit manager has the authority. The experienced nurse in this scenario may or may not be the unit manager. Rationale 3: A leader is not necessarily a good manager and may not be efficient. Rationale 4: A nursing leader must be a visionary in order to empower others to make needed changes for the good of the group. This leader may or not be the formal leader of the group.

The nursing committee is planning a change in the units organization. Which statement reflects the priority expected outcome of these change agents work? 1. The nurses involved will demonstrate management skills. 2. The nurses will agree with the change and present a united front for its adoption. 3. The change will guide nursing practice on the unit. 4. The change will lead to improved client care on the unit.

Correct Answer: 4 Rationale 1: Demonstration of management skills is not the priority expected outcome. Rationale 2: Agreement and presentation of a united front is not the priority expected outcome. Rationale 3: It is hoped that the changes will guide nursing practice, but this is not the priority expected outcome. Rationale 4: All nursing responsibilities and changes have the expected outcome of improving client care.

The nurse manager has scheduled a series of meetings with employees to solve a unit problem. The manager purposefully created a 2-week gap in the meetings to allow which portion of the creative process to occur? 1. Farsight 2. Verification 3. Preparation 4. Incubation

Correct Answer: 4 Rationale 1: Farsight is not part of this process. Rationale 2: Verification is evaluation of the solutions effectiveness. Rationale 3: Preparation is planning time. Rationale 4: The period of lapsed time before a decision is made is the incubation time.

Which action will have the greatest impact on the successful implementation of a planned change? 1. Disciplining individuals who continue to be resisters to the change 2. Ensuring there are no remaining pockets of disagreement when the change occurs 3. Continually rewarding those working toward the change and ignoring those who are not 4. Creating a supportive environment for those undergoing the change

Correct Answer: 4 Rationale 1: It is true that in some cases resisters are so disruptive that they must be disciplined. This is not the best method of assuring successful implementation of a change. Rationale 2: It is unlikely that everyone affected by the change will see it as positive. Attempts to ensure that everyone is happy with the change are generally a waste of energy and resources. Rationale 3: Rewards can be positive, but ignoring resisters is dangerous. Rationale 4: A supportive work environment for those experiencing the change is the strategy most likely to result in an easier transition.

A group of nurses has been convened to solve a problem. As the first step in this process, the group leader asks for a definition of the problem to be solved. Which statement reflects the best problem statement? 1. Emergency department nurses do not make professional client handoff reports. 2. Long-term-care facility nurses lack the education to make complete assessments prior to client transfers. 3. Housekeepers are getting sloppy about cleaning rooms. 4. Unit clerks have made 10 transcription errors in the last 6 months.

Correct Answer: 4 Rationale 1: This is a judgment statement. Rationale 2: This is a judgment statement. Rationale 3: Getting sloppy is a judgment statement. Rationale 4: A good problem statement reflects the facts without judgment as to cause.

A client needs a high-risk surgical procedure. According to the Leapfrog Group, the client should choose which hospital for care during this procedure? 1. The hospital closest to the clients home 2. The hospital that has done the greatest number of these surgeries in the last two years 3. The hospital chosen by the clients primary care physician 4. The hospital with the highest performance ratings for this procedure

Correct Answer: 4 Rationale 1: This may or may not be the best choice of hospital for this procedure. Rationale 2: Just because a hospital is high volume does not mean it is high quality. Rationale 3: This may or may not be the best hospital for this procedure. Rationale 4: The Leapfrog Group focuses on quality indicators including the use of higher-performing hospitals for high-risk procedures.

Which statements by the nurse manager would demonstrate effective change management? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. If this approach doesnt work, at least we can say weve tried. 2. Lets wait until the administration has completed their reorganization before we implement change. 3. In order for this plan to work, everyone must agree to participate. 4. We cannot lose sight of the mission and values of our institution as we begin to integrate these changes. 5. Although this task is going to be difficult, we have the full support of our hospital administration.

Correct Answer: 4,5 Rationale 1: This statement suggests that the manager is not completely behind the projected change. This lack of decisiveness may confuse supporters of the change and encourage resisters to keep resisting. Rationale 2: This statement suggests that the manager may not be completely in favor of the change. In some cases the staunchest resister is the manager. Rationale 3: If the nurse manager waits until everyone agrees to be a participant in change, change will never occur. Rationale 4: All changes and actions that occur within an organization should flow from the mission and values. Rationale 5: It is important to acknowledge that change is difficult. Full support of the administration makes change easier.

The nurse manager consistently refocuses the staff on achieving outcomes and directly involves the staff in decision making to achieve those outcomes. How would this style of leadership be described? 1. Quantum 2. Transactional 3. Contingency 4. Transformational

Correct Answer: 1 Rationale 1: Quantum leadership is based on the concepts of chaos theory, with the focus on outcomes. Rationale 2: Transactional leadership is based on the principles of social exchange theory. Rationale 3: Contingency theory suggests that managers adapt their leadership styles in relation to changing situations. Rationale 4: Transformational leadership emphasizes the importance of interpersonal relationships to inspire and motivate followers.

Which statements by a nurse in the emergency department are examples of groupthink? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Weve already talked about this enough. We need to present a united front on this issue. 2. The medical unit nurses wont like this decision because it is too much work. 3. Lets all vote yes on this so we can get back to work. 4. We need to consider the workload of the intensive care unit nurses. 5. Does anyone else have any ideas to discuss?

Correct Answer: 1,2,3 Rationale 1: Suppression of dissent and new ideas occurs with groupthink. Rationale 2: Stereotyping outsiders is a symptom of groupthink. Rationale 3: There is a strong tendency in groupthink to seek concurrence. Rationale 4: Considering the opinion of others is not a symptom of groupthink. Rationale 5: Leadership controls the discussion and numbers of topics to be discussed in groupthink.

The nurse manager feels that changing the units method of assigning break times would benefit the flow of client care. What should be the managers first action associated with this idea? 1. Tell the staff that a change is coming, but that it is positive and they should not be worried. 2. Collect and analyze information about how the current system is working. 3. Mention in a staff meeting that the current system is causing a lot of trouble. 4. Identify how the manager would know if the change is benefiting the unit.

Correct Answer: 2 Rationale 1: It is not a good idea to indicate that a change is coming until further planning is completed. Rationale 2: Assessment is the first step of the change process, just as it is the first step of the nursing process. Rationale 3: Planting the seed of discontent with the status quo occurs after the problem has been assessed. Rationale 4: Operational indicators of success are developed when the planning phase is near completion.

A newly licensed nurse working on a unit committee challenges every detail of a proposal the committee is developing. How should other committee members interpret this behavior? 1. This nurse is too inexperienced to realize the behavior is inappropriate. 2. This nurse is learning to be creative. 3. This nurse believes that new nurses are more knowledgeable than those who have worked several years. 4. This nurse misunderstands the work of the committee.

Correct Answer: 2 Rationale 1: This behavior is not inappropriate. Rationale 2: Challenging details is a part of the preparation portion of learning to be creative. Rationale 3: There is no indication that this is the belief of this nurse. Rationale 4: There is no indication that this nurse does not understand the work of the committee.

To address the problem of increasing costs of staffing agencies, a hospital has developed a plan for an internal float pool of nurses to be used when scheduled staff nurses call in sick. What type of planning has the administrative staff done? 1. Strategic 2. Organizational 3. Directive 4. Contingency

Correct Answer: 4 Rationale 1: Strategic planning is prioritizing long-term goals. Rationale 2: Organizing is related to planning to get the work done. Rationale 3: Directing is related to planning to get the work done. Rationale 4: Contingency planning is a proactive response to problems that may interfere with getting work done.

What is occurring as the traditional parallel structure found in hospitals is being replaced by service-line structure? 1. Adaptation and innovation are encouraged. 2. The medical staff has become autonomous from the organization. 3. Two lines of authority have been created. 4. Organizational structure is becoming much clearer.

Correct Answer: 1 Rationale 1: Service-line structure is appropriate when environmental uncertainty is high and the organization requires frequent adaptation and innovation. Rationale 2: The medical staff is autonomous from the organization in parallel structure. This autonomy is reduced by service-line structure. Rationale 3: Parallel structure exists when there are two lines of authority in an organization. Rationale 4: Organizational structure is much clearer in a parallel structure. Global Rationale:

A nurse working in a rehabilitation center notices clients frequently asking for something to drink. Which response indicates the use of creativity in finding a solution to this problem? 1. Calling local beverage distributors to inquire about service pricing 2. Asking all employees to write down their ideas about a solution 3. Determining what type of drinks most clients might want 4. Encouraging clients to bring a drink from home

Correct Answer: 2 Rationale 1: Calling a local beverage distributor is a classic way to address this problem and does not engage the creativity of the staff. Rationale 2: Asking others to think about different options opens up the possibilities beyond one individuals ideas. This is part of the preparation stage of creativity. Rationale 3: Finding out the drink preferences of the clients is part of the standard information gathering stage of providing drinks and does not reflect creativity. Rationale 4: Simply encouraging clients to bring a drink from home is not a creative approach to solving this problem.

When faced with the prospect of change, the nurse states, We have always done it this way and never had any problems. A few weeks later, the same nurse remarks, This new way seems to work better than the old way did. This statement is characteristic of which type of change response? 1. Laggards 2. Early adopters 3. Early majority 4. Innovators

Correct Answer: 3 Rationale 1: Laggards dislike change and are openly antagonistic. Rationale 2: Early adopters are not as eager to change as are innovators but are still receptive to change. Rationale 3: The early majority prefers the status quo but eventually accepts change. Rationale 4: Innovators love change and thrive on it.

A nurse practitioner and a physician have opened an office together. The nurse regularly collaborates with the physician in client care and is a general partner in the business of the office. This is an example of which diversification method? 1. Concentric diversification 2. Conglomerate diversification 3. Capitation 4. Joint venture

Correct Answer: 4 Rationale 1: Concentric diversification is expansion of services into new markets. Rationale 2: Conglomerate diversification is expansion into areas that differ from the original service. Rationale 3: Capitation is a fixed fee paid per enrollee for services in an HMO. Rationale 4: A joint venture is a partnership in which each partner contributes different areas of expertise or resources to create a product or service.

The administration of a health care system advertises that it promotes a healthy work environment. Which events would cause a nurse working in this system to question this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse collaborating with physical therapy to establish mutually agreeable treatment schedules lobbies physicians to support nursings position in any disagreements. 2. When staff nurses ask for the nurse managers opinion on client care issues, the response is frequently, Ill leave that decision up to you. 3. Administration has developed a plan in which each week two nurses from each unit are recognized as best nurse of the week. 4. The nurse managers of each unit make a true effort to provide adequate staffing on each shift. 5. The nurse executive communicates with managers mostly by email.

Correct Answer: 1,2,3,5

A nursing committee has been organized to help plan a new intensive care service at the hospital. Which questions are essential for this committee to consider? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Where will the service be housed? 2. Why were the nurses asked to participate? 3. When will the service begin? 4. Who will provide the services? 5. How will money for the project be raised?

Correct Answer: 1,3,4 Rationale 1: Where is an important question in planning. Rationale 2: While it is important to ask why when planning, the correct why in this case is Why are we providing this service? Rationale 3: When is an important aspect of planning. The timeline for implementation is critical. Rationale 4: There are numerous possibilities for answering this question. It is important to consider when planning. Rationale 5: This question is not as essential for this committee. Finding money for the project would not be a nursing function.

A nurse believes that milk is part of the healthy adults diet. The nurse frequently offers milk to adults as a between-meal beverage. This action is based on which concept? 1. Evidence 2. An underlying assumption 3. An alternative perspective 4. An inquiring attitude

Correct Answer: 2 Rationale 1: Scientific evidence shows that milk is not tolerated by all adults. This action is not based in science. Rationale 2: The nurses assumption is that milk is good for adults. Rationale 3: The nurse has not considered the alternative perspective that milk is not tolerated by some adults. Rationale 4: An inquiring attitude would lead the nurse to investigate research about adult tolerance to milk.

The nurse manager is planning to initiate new policies in the department and is reviewing several change theories. Which step of Havelocks model will the nurse find most closely resembles Lewins moving stage? 1. Self-renewal occurs among all participants. 2. Solutions are identified to create change. 3. Resources are acquired to facilitate change. 4. Relationships are formed among all participants.

Correct Answer: 2 Rationale 1: Self-renewal and stabilization occur during the final stage and are most like Lewins refreezing stage of change. Rationale 2: Choosing a solution and gaining acceptance are most like Lewins moving stage. Previous to this stage in both models, the work is to convince participants that change is necessary and to secure resources for the change. After solutions are identified and implemented, the final stage begins. Rationale 3: The first three steps of Havelocks theory are building a relationship, diagnosing the problem, and acquiring resources. These three steps are most like Lewins unfreezing stage. Rationale 4: The first step of Havelocks model is building relationships among participants. This is one of the steps that are equivalent to Lewins unfreezing stage.

The community hospital is considering a redesign initiative. As part of a SWOT analysis, nurses on the strategic planning committee have been asked to distribute surveys to stakeholders. The nurses will contact which groups? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Experts in hospital physical design 2. Other nurses who work at the hospital 3. Physicians 4. Hospital administrators 5. Representatives from local insurance offices

Correct Answer: 2,3,4,5 Rationale 1: Experts in hospital physical design are considered a resource rather than stakeholders. Rationale 2: Employees of the hospital are considered stakeholders. Rationale 3: Physicians are considered stakeholders. Rationale 4: Administrators are considered stakeholders. Rationale 5: Community representatives are considered stakeholders.

Question 22 Type: MCSA As a result of retirements, resignations, and reorganization, a nurse became nurse manager of a high-acuity unit 3 months after being licensed. The manager struggles with the responsibilities of the position and is often unable to make decisions. Which component of the AONE management competencies does this nurse probably lack? 1. Foundational thinking skills 2. Personal and professional accountability 3. Clinical practice knowledge 4. Effective communication skills

Correct Answer: 3 Rationale 1: There is no evidence that this nurse lacks foundational thinking skills. Rationale 2: There is no evidence that this nurse lacks personal and professional accountability. Rationale 3: To effectively manage a high-acuity unit, the nurse must have sufficient experience to develop clinical practice knowledge. Three months is not long enough for that to occur. Rationale 4: There is no evidence that this nurse does not have effective communication skills.

Which topic would likely appear on the agenda for a staff meeting chaired by a nurse manager who follows transactional leadership theory? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Progress on request to increase personal day benefits 2. Review of policy and procedure for unit evacuation 3. The value of teamwork 4. Being empathetic with clients 5. Standardized first of shift assessments

Correct Answer: 1,2,3,5 Rationale 1: Transactional leadership uses personal reward as a method of maintaining the status quo. Rationale 2: Transactional leaders value policy and procedure. Rationale 3: Interpersonal dependence is valued by transactional leaders. Rationale 4: An emphasis on empathy, awareness, and persuasion is more characteristic of servant leadership. Rationale 5: Transactional leaders value standardization.

Question 2 Type: MCMA According to the behavioral view of leadership, how are leaders formed? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. By being educated 2. From inborn traits 3. With training 4. Through life experiences 5. Through abilities

Correct Answer: 1,3,4 Rationale 1: Behavioralists believe leaders are made, not born. Leaders become good at leading through formal education, experience in leadership roles, and training in leadership seminars. Rationale 2: Some researchers believe leaders are born with personality traits that make them successful in leadership. This is not part of behavioral theory. Rationale 3: Behavioralists believe leaders are made, not born. Leaders become good at leading through formal education, experience in leadership roles, and training in leadership seminars. Rationale 4: Behavioralists believe leaders are made, not born. Leaders become good at leading through formal education, experience in leadership roles, and training in leadership seminars. Rationale 5: Abilities may develop in a variety of ways. This is not a part of behavioral theory.

The health care facility has elected to make a significant change in organization strategy. The change has been thoroughly researched and all levels of leadership have been included in the decision. Which roles are commonly undertaken by the nurse manager when such a change is necessary? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Disciplinarian 2. Resister 3. Fact manager 4. Liaison 5. Support person 6. Discussion leader

Correct Answer: 1,3,4,5,6 Rationale 1: The nurse manager may be placed in the role of disciplining staff members who are impeding the work of the organization. Rationale 2: Once the decision to make a change has been made, the nurse manager should not act as a resister. Rationale 3: The nurse manager may be in the role of one who supplies information about the needed change. Rationale 4: The nurse manager may act as a liaison between the committee and the staff. Rationale 5: The nurse manager fulfills the role of support person for staff adapting to the change Rationale 6: The nurse manager may act as discussion leader, both in formal and informal discussions.

The nurse executive is reviewing statistics about the nursing staff. Which statistic shows that the staff reflects national trends? 1. The average age of the nursing staff is 40. 2. The number of nurses under age 30 has increased in the last two years. 3. There are no nurses over age 55. 4. All nurses over age 45 are managers.

Correct Answer: 2 Rationale 1: The average age of nurses is 46. Rationale 2: The number of nurses under age 30 is increasing. Rationale 3: This does not reflect national statistics. Rationale 4: This does not reflect national statistics.

The nurse manager has established a program that recognizes a different staff member each month for contributions to client care. As a result, overall staff productivity and the number of client compliments have increased. This is an example of which concept of organizational theory? 1. Span of control 2. Line authority 3. Hawthorne effect 4. Adhocracy

Correct Answer: 3 Rationale 1: Span of control is the number of persons a manager can effectively supervise. Rationale 2: Line authority is a linear hierarchy through which activity is directed. Rationale 3: The Hawthorne effect is the tendency of people to perform as expected because of special attention. Rationale 4: Adhocracy is a fluid structure in which management, staff, and experts work together on teams.

A hospitalized client is complaining of abdominal pain that has developed since admission. The nurse says, I am going to call the hospitalist. How should the client interpret this statement? 1. The nurse is going to call the medical intern to assess the client. 2. The nurse is going to call the clients physicians on-call group. 3. The nurse is going to call a physician who cares for inpatients. 4. The nurse is going to call the emergency department and request that a physician see this client.

Correct Answer: 3 Rationale 1: The medical intern is not a hospitalist. Rationale 2: The physicians on-call group is likely a group of physicians from the same office or organization of physicians with office practices. They are not hospitalists. Rationale 3: A hospitalist provides care only to hospital inpatients. Rationale 4: Emergency department physicians are not the same as hospitalists.

During a discussion of how to proceed on a project, a team member says, I dont care how we do it. Just tell me what to do and I will get it done. What kind of followership is this nurse exhibiting? 1. Passive 2. Active 3. Dependent 4. Independent

Correct Answer: 3 Rationale 1: The nurse is not passively participating. There is an indication that the work will be done. Rationale 2: The active follower would express ideas on how to achieve the goal. Rationale 3: This dependent you make the decision and Ill do it statement is characteristic of an ineffective follower. Rationale 4: An independent follower would express constructive criticism of plans.

at the beginning of a brainstorming session, the manager lists the rules to be followed. Which rule should be included and enforced? 1. Do not suggest any solution that is prohibitively expensive. 2. Suggest only ideas that the group has not already tried. 3. Do not critique any ideas presented. 4. Limit the session to the first 15 ideas.

Correct Answer: 3 Rationale 1: While all organizations are governed by a budget, what is prohibitive to one committee member may not be so to another. All solutions should be expressed. Rationale 2: Sometimes an old solution is workable. Rationale 3: Brainstorming is for idea generation only. Idea critique will follow in another session. Rationale 4: The idea of brainstorming is to generate lots of ideas quickly. It would be better to limit the time than to limit the number of ideas.

A nursing curriculum includes integrated content on critical thinking. Which statement reflects movement toward designing the curriculum to meet Carnegie Foundation recommendations? 1. We must find ways to increase our emphasis on critical thinking. 2. The curriculum must focus on ways nurses can quickly and accurately acquire information. 3. Our emphasis must change to improving students clinical reasoning skills. 4. Our clinical practicums must be graded separately from our theory presentations.

Correct Answer: 3 Rationale 1: Critical thinking is still emphasized, but another aspect of care should receive much more emphasis. Rationale 2: Carnegie focuses on application of knowledge rather than its acquisition. Rationale 3: This is a Carnegie recommendation. Rationale 4: Carnegie recommends integration of clinical and classroom teaching.

The health care institution has organized a committee to review and revise the strategic plan. As part of this work, committee members have been asked to submit a philosophy statement for consideration. Which statement meets the requirements of a philosophy? 1. We will increase client satisfaction by 15 percent. 2. We will increase productivity by 10 percent on the surgical floor. 3. We believe in honest communication. 4. We believe clients are most important.

Correct Answer: 4 Rationale 1: This statement specifies an outcome to be achieved. This is a goal. Rationale 2: This statement is specific to a particular unit and is an objective. Rationale 3: This is a statement of the organizations values. Rationale 4: The philosophy is a written statement that reflects the organizations values, vision, and mission. It is broader than a value statement.

Question 20 Type: MCSA The nurse has been asked to assume a first-level management role on the nursing unit. Which statement indicates that this nurse will need further mentoring in the new role? 1. I wont be able to increase my teams motivation. That has to come from within them. 2. As a manager, I will be available for my team if problems with clients arise. 3. One of my roles will be to make sure assignments are clear and understandable. 4. I will still be responsible for the care being provided even if I am off the unit during the day to attend meetings.

Correct Answer: 1 Rationale 1: Managers can affect motivation by developing strategies and possible incentives. The other options are true management functions. Rationale 2: Being available for consultation or help with assignments is one of the roles of the first-level manager. Rationale 3: First-level managers are responsible for supervising the work of nonmanagerial personnel and the day-to-day activities of a specific work unit or units. Clarity of assignment is part of this supervision. Rationale 4: First-level managers are responsible for attending meetings and may be away from the unit while retaining responsibility for the care being provided. Global Rationale:

Which organization would the hospital management team contact to pursue certification as a Magnet hospital? 1. Magnet Recognition Program 2. American National Magnet Commission 3. The Joint Commission 4. American Medical Association

Correct Answer: 1 Rationale 1: The Magnet Recognition Program, developed by the American Nurses Credentialing Center, designates health care organizations that provide nursing excellence. Rationale 2: The American National Magnet Commission is fictitious. Rationale 3: The Joint Commission accredits health care organizations, but does not award Magnet status. Rationale 4: The AMA does not award Magnet status. Magnet status is focused on nursing excellence.

Which manager statement reflects concern about the most important requirement for todays nurse manager? 1. I am taking a day off tomorrow for my annual physical. 2. I think this class will help me learn to be innovative. 3. I am committed to being a good manager. 4. I feel enthusiastic about our new plans for the units.

Correct Answer: 1 Rationale 1: The most important work of the manager is to stay physically and mentally healthy. Rationale 2: Innovation is important, but not as important as another factor. Rationale 3: Commitment is important, but is not as important as another factor. Rationale 4: Enthusiasm is important, but is not as important as another factor.

A serious disagreement has arisen between two staff nurses. The unit manager elects not to make a decision regarding the disagreement until more evidence is collected. Which part of the nursing process does this managers critical thinking reflect? 1. Assessment 2. Diagnosis 3. Planning 4. Evaluation

Correct Answer: 2 Rationale 1: Assessment is collecting the evidence. Rationale 2: Suspending judgment is equivalent to the diagnosis step. Rationale 3: Planning would occur when information is collected and analyzed and a course of action is being determined. Rationale 4: Deciding which hypothesis is correct is evaluation.

Which nurse has legitimate leadership authority in the organization? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Staff nurse 2. Nurse manager 3. Case manager 4. Quality improvement coordinator 5. Education specialist

Correct Answer: 2,3 Rationale 1: Staff nurses are not seen as having legitimate leadership authority. Staff nursing is not a management or leadership role. Rationale 2: Nurse managers have legitimate authority conferred by the organization and described in job descriptions. Rationale 3: Case managers have legitimate authority conferred by the organization and described in job descriptions. Rationale 4: The leadership of the quality improvement coordinator is informal and stems from the nurses knowledge. Rationale 5: The leadership of the education specialist is informal and stems from the nurses knowledge.

To be effective in todays health care system, the nurse manager must be aware of which trends? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. An environment that does not change 2. Decreasing resources 3. Adequate staffing 4. Increasing numbers of retirees 5. Complicated technology

Correct Answer: 2,4,5 Rationale 1: The only trend that is consistent is the rapidly changing system. Rationale 2: Nurse managers must be aware of the responsibility of doing more with fewer resources. Rationale 3: Often the nurse manager is faced with staffing inadequate for the acuity of the clients requiring care. Rationale 4: Increasing numbers of retirees, both from nursing and as an aging population, have placed strain on the health care system. Rationale 5: Complicated technology forces the nurse manager to keep up with the ever-present changes within the health care system.

What is the most common skill shared by effective nurse leaders in leadership theories or models? 1. Critical care experience 2. Political knowledge 3. Communication 4. Informal power

Correct Answer: 3 Rationale 1: Critical care experience is not necessary for effective leadership. Rationale 2: A leader may or may not have political knowledge but should have knowledge of and involvement in the community. Rationale 3: Regardless of the type of leader or the type of unit a nurse manages, communication skills are the key to effective leadership. Rationale 4: An effective leader may have formal power only.

The nursing group has been charged with the task of solving a patient care problem on the units. Which step should this group take first in this process? 1. Investigate what has already been tried to solve the issue. 2. Brainstorm about potential solutions. 3. Gather information to define the problem. 4. Categorize information in order of reliability.

Correct Answer: 3 Rationale 1: Once the problem has been identified, the group would then look at solutions that have already been tried. Rationale 2: Brainstorming is used to develop solutions after information about the problem is analyzed. Rationale 3: Problem solving begins with collecting the facts, which provides clues to the scope and solution of the problem. Rationale 4: Information cannot be sorted into an orderly arrangement until it has been collected.

The nursing faculty would like to incorporate problem-based learning into the curriculum. Which action is essential? 1. Obtain funding for a simulation mannequin. 2. Write standardized scripts for volunteers who will portray clients. 3. Add more information to existing care plans as the study unfolds. 4. Assign client care debate topics to teams of three or four students.

Correct Answer: 3 Rationale 1: Simulation mannequins are not essential for problem-based learning. Rationale 2: It is not essential to have a person who portrays a client in order to conduct problem-based learning. Rationale 3: Problem-based learning exists when students are exposed to what comes next in a case study. Additional information is revealed as the case study progresses. Rationale 4: Debates are a way to encourage innovation but are not essential for problem-based learning.

A nurse manager encourages nursing staff members to assist in developing a new creative staffing pattern that can respond quickly when staff resign or go back to school. This is an example of the use of which organizational theory? 1. Contingency theory 2. Closed-systems theory 3. Classical theory 4. Chaos theory

Correct Answer: 4 Rationale 1: Contingency theorists study the environment in which the organization will exist and create the structure to match that environment. Rationale 2: Closed systems are self-contained and do not exist in organizations dependent on the interplay of people. Examples can be found in the physical sciences. Rationale 3: Classical leadership theory focuses on developing a well-structured and stable environment where chain of command and control are valued. Rationale 4: Chaos theory posits that an organization is dependent on its adaptability and response to change in its environment. Nurse managers must create an environment that accepts change, tolerates conflict, and promotes creative solutions.

The organization that awards Magnet status would look for environments where which practices are the norm? Standard Text: Select all that apply. 1. Nurses are involved in decision making. 2. Rewards are focused on ideas that save money. 3. Once a decision is made, it stands. 4. Nurses may be asked to work overtime. 5. Nurses are involved in educating the community about health.

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A disagreement has arisen between two staff nurses. Both have discussed the situation with the manager. The manager feels that that problem is likely self-solving. How should the manager approach this situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Allow some time to pass to see if the situation resolves. 2. Support both nurses as they work through this issue. 3. Provide any resources the nurses may need to help solve the problem. 4. Intervene if the problem begins to impact client care. 5. Ignore the situation.

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The nurse manager overhears staff discussing the shortage of nurses. Which statement by a staff member would the manager evaluate as misinformation? 1. There are more nurses retiring than are entering the profession. 2. The demand for nurses is declining because of fewer hospital admissions. 3. There are insufficient numbers of nursing faculty to teach interested students. 4. Women still outnumber men in nursing.

2 Rationale 1: The average age of the registered nurse is 46 years, and while the number of RNs under age 30 is increasing, more RNs are retiring than are entering the profession. Rationale 2: The demand for nurses is increasing because of sicker clients both in the hospital and in outpatient settings. Job numbers for nurses are expected to continue to grow. Rationale 3: Nursing faculty members are also aging and moving into retirement. Rationale 4: Women do continue to outnumber men in the nursing profession.

A health care organization has just achieved Magnet status. During the award ceremony the organizations chief executive officer should give primary praise for this achievement to which employees? Standard Text: Select all that apply. 1. Medical staff 2. Nurse executive 3. Staff nurses 4. Managers in support services such as laboratory and radiology 5. Administrative professionals overseeing services such as accounting, billing, and medical records

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The nurse manager has four different generations represented in the nursing staff on the unit. What statements indicate the manager is wise about how to deal with this generational mix? 1. I dont see why everyone cant just get along. 2. Generation X nurses are just lazy. 3. Our Generation Y nurses help keep us all up on new technology. 4. The most loyal of all my nurses are the traditionalists. 5. I expect that our next manager will come from my group of baby boomers.

3,4,5, Rationale 1: The four generations have different values, work ethics, and skills. Conflict is inevitable. Rationale 2: The manager should not stereotype the members of a generation. Rationale 3: Generation Y is technically savvy. Rationale 4: Traditionalists are typically loyal and respectful of authority. Rationale 5: Baby boomers typically value professional and personal growth.

Which strategy is most likely to increase participation in the use of evidence-based practice in nursing? 1. Ensure adequate training and encourage its use by the nursing staff. 2. Elicit employee opinions of its use at least four times per year. 3. Give those nurses willing to use it extra recognition. 4. Ensure adequate training, recognition, and easy access to the Internet.

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A new IV pump has just been purchased by the facility. Which statement by the nurse manager reflects Rogers first step in making the change to this new equipment? 1. The nursing staff will have the final decision on whether to change to this IV pump. 2. Before we make the final decision, we will do a 3-month test run of the equipment to make sure we like it. 3. I have looked at the pump and I like it. 4. I have information to share with you about the new IV pump we are considering for the unit.

4 Rationale 1: Telling the staff that they have the final decision is a way of persuading. Rationale 2: The decision to adopt or reject a change occurs after the knowledge and persuasion steps. Rationale 3: Giving a personal endorsement of the change would be persuasion. Rationale 4: The first step of the diffusion of innovation occurs when the decision-making unit is introduced to the innovation and knowledge is gained.

During a nurses interview for a new job, the health benefits are described as being provided by a health maintenance organization (HMO). What should the nurse expect from this coverage? 1. The nurse will have to choose a provider from within the HMO. 2. The nurse can obtain services from a nonparticipating provider and the HMO will pay for a portion of the charges. 3. For an additional premium, the nurse can choose any provider. 4. By joining this HMO, the nurse is entitled to unlimited treatment and services.

Correct Answer: 1 Rationale 1: An HMO is a geographically organized system that provides an agreed-upon package of health maintenance and treatment services. Providers must be chosen from those in the HMO. Rationale 2: The HMO system will not pay for services provided out of network. Rationale 3: The ability to choose a provider who is out of network for an additional premium is a feature of point-of-service plans. Rationale 4: The HMO provides an agreed-upon package of health maintenance and treatment services. Treatment and services are not unlimited.

The quality management director of a large health care conglomerate wishes to initiate benchmarking strategies to assess care. Which directive should this manager publish? 1. We will compare outcome indicators with other health care conglomerates of similar size and organization. 2. Outcome data of hospitals within the organization will be compared to assess quality. 3. Each client care unit in the organization will establish specific unit goals for quality. 4. Each unit in the organization will create a quality monitor to assess how well unit policies are followed.

Correct Answer: 1 Rationale 1: Benchmarking uses an organizations outcome data and compares it with that of a similar organization to address strengths and challenges. Rationale 2: Because the hospitals with the organization are likely managed in similar manner, this is not an example of benchmarking. Rationale 3: While establishing goals is a part of quality management, it is not benchmarking. Rationale 4: Setting up a quality monitor is a quality initiative, but it is not benchmarking.

Question 1 Type: MCSA The nurse manager is challenged to find an innovative way to adequately staff the unit and provide quality nursing care. Which ability would be most useful to the nurse in this situation? 1. Creativity 2. Problem solving 3. Brainstorming 4. Decision making

Correct Answer: 1 Rationale 1: Creativity is a part of the critical-thinking process that fosters the development and implementation of new approaches to different situations. Rationale 2: Problem solving implies there is a problem that needs a solution. Rationale 3: Brainstorming generates diverse ideas with many superficial solutions. Rationale 4: Decision making identifies one effective strategy that is not necessarily innovative.

The nurse is using critical thinking skills to decide which of several options is the best. Which question is most important for the nurse to take into consideration? 1. Are there different situational effects or contexts to be considered? 2. How has the problem usually been handled? 3. What is the easiest and least expensive alternative? 4. Can the problem be solved using the nursing process?

Correct Answer: 1 Rationale 1: Critical thinking involves choosing the best alternative from several, depending on the situation in which the problem occurred. This is the context of the problem. Rationale 2: Handling the problem the way its usually handled may be easy but would not involve critical thinking. Rationale 3: Choosing the easiest or least expensive alternative may be easy but would not involve critical thinking. Rationale 4: The nursing process should be used in critical thinking, but the changing situation is the more defining and specific characteristic of critical thinking.

Which situation is an example of a major weakness of service-integrated structure? 1. Two different units have purchased a demonstration model that could be used by both units. 2. The pharmacy has been asked to compromise on the times medications are delivered to the units. 3. Nurse managers in several units are interviewing new graduates for staff positions. 4. The nurse manager of a unit is involved in a conflict between hospital management and the medical staff.

Correct Answer: 1 Rationale 1: Duplication of resources is a major weakness of service-integrated structures. Rationale 2: Coordination across functions and the ability to coordinate, collaborate, and compromise are strengths of service-integrated structure. Rationale 3: One of the strengths of a service-integrated structure is that the same activities can occur in several units and can be unit specific. Rationale 4: When there are two lines of authority, as in the parallel structure, conflicts may occur at the department or unit level.

The nurse manager is facilitating change to a new documentation system in the unit. If the manager wants to use the most common method to overcome resistance to the change, which strategy would be chosen? 1. The manager distributes a handout explaining the new system and how to use it. 2. The manager creates a quick tip sheet about how to use the system and schedules practice sessions for each nurse. 3. The manager identifies a key supporter of the change and has that nurse act as mentor to the remaining staff. 4. The manager threatens to transfer anyone who resists the change.

Correct Answer: 1 Rationale 1: Giving information is the most common method of changing individuals perceptions, attitudes, and values. Rationale 2: Providing information and an opportunity to practice is called training. Training is not the most common method of changing perceptions, attitudes, and values. Rationale 3: While having a mentor may be a desirable method for the learner, it is not the most common method of changing perceptions, attitudes, and values. Rationale 4: Transferring or terminating those who resist change is a method of changing the perceptions, attitudes, and values of the remaining staff. It is not the most common method.

A long-term care facilitys organization reflects a functional structure. Which facility practice reflects a basic weakness in this organizational strategy? 1. The nursing department is responsible for writing the clients comprehensive care plan. 2. The dietary department is responsible for nutritional assessment. 3. All nursing tasks fall under the nursing department. 4. Physical and occupational therapy departments coordinate and evaluate activities of daily living.

Correct Answer: 1 Rationale 1: In functional structure, individual departments are grouped and responsible for specific tasks. A weakness of the functional structure is that coordination of services across departments is poor. Nursing would find it difficult to write a comprehensive care plan without input from other departments. Rationale 2: In functional structure, individual departments are grouped and responsible for specific tasks. The dietary department would be responsible for nutritional assessment in this structure, so this is not a weakness. Rationale 3: In functional structure, individual departments are grouped and responsible for specific tasks. All nursing tasks would be grouped under the nursing department, so this is not a weakness. Rationale 4: In functional structure, individual departments are grouped and responsible for specific tasks. Physical and occupational therapy would logically coordinate and evaluate activities of daily living, so this is not a weakness.

Question 16 Type: MCSA The nurse manager is working on a committee whose task is to review and revise job descriptions for nursing employees. In which job description would the committee most likely include the phrase Management responsibilities include shift-by-shift coordination and promotion of quality client care? 1. Charge nurse 2. Staff nurse 3. Clinical nurse leader 4. Nurse executive

Correct Answer: 1 Rationale 1: The charge nurse is unique to the health care setting and assists with shift-by-shift coordination and promotion of quality client care as well as efficient use of resources. Rationale 2: The staff nurse is not formally a manager. This nurse is responsible for promotion of quality care for the shift worked. Rationale 3: The clinical nurse leader is not a manager but rather works as a resource to those providing direct care. This nurse may coordinate care at the bedside and works to integrate care. Rationale 4: The nurse executive is an upper-level manager and is responsible for quality care across the institution.

A nurse manager is participating in the health care organizations strategic planning committee. Which factor is the primary driving force and controlling factor in new initiatives this committee might recommend? 1. Cost of care 2. Access to care 3. Availability of care 4. Quality of care

Correct Answer: 1 Rationale 1: While all of the options given are driving forces in todays health care environment, the cost of providing care is still the primary issue. Cost of care controls access, availability, and even quality. Rationale 2: Access to care is controlled by the ability to pay for that access. Rationale 3: Care will not be available if it cannot be funded. Rationale 4: Health care providers do not like to correlate quality with cost, but the economic reality is that quality care must also be funded care.

The hospital has a very formal organizational structure and culture. Which conditions or events would indicate that a counterculture is developing within this hospital? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Collaboration and work sharing are becoming more common among nurses in specialty care units. 2. An informal group of nurses, radiology technicians, and physical therapists have been discussing how to better care for clients with hip replacements. 3. Nurses have begun questioning the wisdom of standardizing some nursing procedures. 4. Staffing has become less flexible as more nurses specialize in one aspect of care. 5. A recently updated organizational chart indicates the line authority for each position.

Correct Answer: 1,2,3 Rationale 1: Collaboration and work sharing are more closely identified with systems theory. Rationale 2: In the classical approach, work is divided into departments and specialties. Rationale 3: Standardization is a means of control of work, which is common in the classical organizational approach. Rationale 4: Specialization of labor is a common finding in classical theory. Rationale 5: Chain of command and line authority are characteristic of classical theory.

A nursing supervisor would like the nurse manager to serve as change agent for a needed revision to unit policy. Which statements would alert the supervisor that this manager is not the best choice for this assignment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Well, we dont want to rock the boat too much. 2. Do you think we can get enough support from the nurses to make this change? 3. We tried making a change like this before and it didnt work out well. 4. To make this big change, we need to start making smaller changes now. 5. There is going to be resistance, but I think it can be overcome.

Correct Answer: 1,2,3 Rationale 1: Fear of rocking the boat may prevent the manager from effectively leading the change. Rationale 2: Fear that no one will support the change may prevent the manager from effectively leading the change. Rationale 3: Recalling that previous efforts at change have failed may prevent the manager from effectively leading the change. Rationale 4: The ability to see the end result and what it will take to make the plan work is a sign that the manager could be an effective change agent. Rationale 5: The ability to handle resistance and a display of confidence are signs that the manager could be an effective change agent.

Which statements by a hospital executive reflect power-coercive strategies to implement change? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. We must follow the federal guidelines in the way we bill for our services. 2. If we dont reduce our nosocomial infection rate, Medicare wont reimburse us. 3. Administration has to make this change or our accreditation status will be at risk. 4. This change is the only logical action we can take. 5. All our sister institutions in the association have already made this change.

Correct Answer: 1,2,3 Rationale 1: Power-coercive strategies are based on the application of power by a legitimate authorityin this case, the federal government. Rationale 2: Power-coercive strategies are based on the application of power by a legitimate authorityin this case, Medicare. Rationale 3: Power-coercive strategies are based on the application of power by a legitimate authorityin this case, the accrediting body. Rationale 4: The empirical-rational model of change focuses on logical actions. Rationale 5: Normative-reeducative strategies rest on the assumption that people act in accordance with social norms and values.

Part of the facilitys performance evaluation is based on the nurses strength in the three types of decisions. During a nurse managers performance evaluation the supervisor says, You are very good at adaptive decisions, but you need to be more precise in routine decisions. When the situation calls for really innovative decisions, you do not seem sure of yourself. How should the manager interpret this information? Standard Text: Select all that apply. 1. I am not following the policies and rules well. 2. I should review the procedure manual. 3. Im good at using my previous experiences to guide my decisions. 4. I am strongest in making decisions when the problems are very unusual or unclear. 5. I make good decisions when the situation is novel.

Correct Answer: 1,2,3 Rationale 1: Routine decisions are based on policies and rules. Rationale 2: Routine decisions are based on procedures. Rationale 3: Adaptive decisions are often modifications of well-known problems or solutions. Rationale 4: Solving unusual or unclear problems requires innovative decision making. Rationale 5: Novel situations require innovative decision-making abilities.

Question 3 Type: MCMA The vice president for nursing services of a large teaching hospital has been aware that many of the problems in the nursing staff result from poor management at the unit level. What are reasons that nurse managers are sometimes ineffective in their role? Standard Text: Select all that apply. 1. There is little training available for nurse management positions. 2. Entry-level educational programs for nurses do not contain sufficient managerial content. 3. Management techniques are often learned on the job. 4. Nurses are not good managers. 5. Nurses often experience poor supervision in their own careers.

Correct Answer: 1,2,3,5 Rationale 1: Few nurses have the training necessary to be managers. Rationale 2: Entry-level education programs are designed to produce generalists, and most content is focused on bedside nursing skills. Rationale 3: Many managers depend on their own experience with former supervisors. Rationale 4: Nurses work as managers of their own practice and can become very good managers when sufficient education and support are provided. Rationale 5: Nurses may manage as they were managed and perpetuate poor management techniques.

Question 17 Type: MCMA The nurse manager is listening to new nurses discussing nurses as managers and overhears one state, I dont care how long I am a nurse; I will never be a manager. In which ways do nurses manage regardless of their official role? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Deciding on priorities 2. Being a liaison 3. Coordination of client care 4. Developing the unit budget 5. Delegation responsibilities

Correct Answer: 1,2,3,5 Rationale 1: Staff nurses are responsible for prioritizing care for the clients for whom they provide care. Rationale 2: Staff nurses act as liaisons between clients and other health care professionals. Rationale 3: Staff nurses work to coordinate care provided by other health care professionals. Rationale 4: Staff nurses may have input into budget development but do not have direct responsibility for the process. Rationale 5: Staff nurses have the responsibility of delegating tasks to nonprofessional staff.

A nursing supervisor has introduced a needed change in policy to the nurse managers. The managers have met maximum resistance when attempting to gain support for the change. Which options reflect valid strategies for the nurse managers? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Meet with the supervisor and discuss modification of the proposed change. 2. Slow down the change process. 3. Meet with the supervisor and suggest abandoning the change. 4. Work together to identify strategies to overcome resistance. 5. Proceed with the change.

Correct Answer: 1,2,4,5 Rationale 1: Modifying the change and compromising with resisters is a valid strategy. Rationale 2: Trying to change too much too fast can escalate resistance. Rationale 3: Abandoning the change is not a viable offer, as the supervisor has indicated that change is needed. Rationale 4: Overcoming resistance is often necessary for change to occur. Rationale 5: In some cases, change must proceed despite resistance. Those who can live with the change stay, and those who cannot leave.

A nurse has accepted the position of vice president in charge of nursing in an organization that has a functional structure. What issues should the nurse be alert for? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. There may be lack of coordination of services across the different departments in the organization. 2. Senior nursing managers may be overwhelmed with work and decisions. 3. There may be unrest because of the high proportion of management positions filled from outside the organization. 4. There is continual upheaval as the organization responds rapidly to changes in the external environment. 5. Managers have limited knowledge of general management techniques.

Correct Answer: 1,2,5 Rationale 1: Coordination across functions can be complex and poor in a functional structure. Rationale 2: Because so many day-to-day operation decisions are made by senior managers in this structure, these people may become overloaded and unable to be efficient in their work. Rationale 3: Typically, in a functional structure, promotion occurs from within. Rationale 4: Typically, response to changes in the external environment is very slow in organizations with functional structure. Rationale 5: Many managers in functionally structured organizations rise up the ranks to their position; there is often very little formal management training.

A nurse manager is committed to establishing an environment that supports critical thinking and creativity. What strategies would help in this effort? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Provide opportunities for staff to interact with nurses from outside the facility. 2. Give the nurses freedom to design their work environment. 3. Create a spreadsheet for nurses to complete describing their creative efforts. 4. Assign each nurse 15 minutes of a staff meeting to talk about his or her creative efforts. 5. Be receptive to ideas even if they seem strange at the beginning.

Correct Answer: 1,2,5 Rationale 1: Exposure to new ideas and a fresh environment outside the facility increases creativity. Rationale 2: Freedom is necessary to support the creative process. Rationale 3: Filling in a spreadsheet is a bureaucratic, regimented strategy that will not foster creativity. Rationale 4: Making creativity an assignment is a sure way to stifle it. Rationale 5: Being receptive to new ideas encourages creativity.

A major change has occurred in the governance of the hospital. How can the nurse manager help staff cope with this change? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Disperse information about the change as quickly as possible. 2. Discourage any negative discussion about the change. 3. Remind staff that change is part of the health care environment. 4. Talk about the change in positive terms. 5. Withdraw slightly from those who oppose the change.

Correct Answer: 1,3,4 Rationale 1: Communicating openly and honestly with those who support the change and those who oppose the change is the best strategy. Rationale 2: The pros and cons of the change should be openly discussed. Rationale 3: Change is constant in health care. Rationale 4: Emphasizing the positive outcomes of the change is a strategy to reduce resistance. Rationale 5: The nurse manager should maintain support for and confidence in all staff.

A nurse executive is considering initiating a blog to enhance communication among staff nurses, managers, and supervisors throughout the organizations different campuses. What serious considerations should the nurse make prior to starting a blog? Standard Text: Select all that apply. 1. Open access to the blog may damage recruiting efforts. 2. Blogs are difficult to use and expensive to maintain. 3. Users of the blog must be very careful not to divulge any information that would violate client confidentiality. 4. The organizations reputation may be altered by a blog. 5. Most nurses would likely not use the blog.

Correct Answer: 1,3,4 Rationale 1: Disgruntled employees may use the blog to air grievances. If the blog is open access, these grievances could quickly become community news. Rationale 2: Blogs are inexpensive and easy to use. Rationale 3: As blogs becomes more and more common, bloggers become more casual in their use. Violations of client confidentiality would not only be possible but could even be said to be likely. Rationale 4: The organizations reputation could be either enhanced or damaged by bloggers comments. Rationale 5: Social media sites such as blogs have exploded in use. It is very likely that nurses would use a blog.

The nurse executive wishes to hire nurse managers who embody the service leadership mission of the organization. Which specific attributes should this nurse look for in applicants? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The ability to be empathetic to clients and staff 2. Ability to sustain high energy for long periods of time 3. Awareness of the needs of clients and the organization 4. Use of persuasion as a leadership technique 5. Long history of leadership success

Correct Answer: 1,3,4 Rationale 1: Empathy is a characteristic of a servant leader. Rationale 2: The ability to sustain high energy is common in many leaders and is not particular to a servant leader. Rationale 3: An awareness of others and their needs is a characteristic of the servant leader. Rationale 4: The use of persuasion is characteristic of the servant leader. Rationale 5: A long history of leadership success is not unique to a servant leader.

Which statement describes the primary difference between group and individual decision making, besides the number of individuals involved? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A decision made by a group is often better than a decision made by one person. 2. A decision made by an individual results in greater commitment. 3. Groups can provide more input into the process. 4. A decision made by a group can create a greater obligation to achieve results. 5. Routine decisions are more often made by individuals.

Correct Answer: 1,3,4,5 Rationale 1: Decisions made by groups are often better than those made by individuals because there is more input into the process. Rationale 2: There is no evidence to support that a decision made by an individual results in greater commitment. Rationale 3: Decisions made by groups are often better than those made by individuals because there is more input into the process. Rationale 4: The peer pressure of a group can create a greater commitment or feeling of obligation to achieve results. Rationale 5: Routine decisions are often made by individuals, with no group input necessary.

Which statements exemplify the attributes of critical thinking essential to nurses? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. I am always curious about why we do things the way we do. 2. I think we need to hurry up and make a decision. 3. Can you help me understand your perspective a little better? 4. I dont think that your concern is necessarily pertinent to this issue. 5. I dont think I can make that decision until I have more information.

Correct Answer: 1,3,5 Rationale 1: Curiosity and a willingness to examine underlying assumptions are characteristic of a critical thinker. Rationale 2: A critical thinker is not in a hurry to make a decision but waits until all the facts are known and can be considered. Rationale 3: The critical thinker considers the possible alternative perspectives. Rationale 4: The critical thinker does not discount the concerns of others who have knowledge of the issue. Rationale 5: The critical thinker collects and analyzes the facts before considering any decision.

A nurse who works for an accrediting agency is reviewing the structure of a health care organization. Which situations would the nurse interpret as indicating the agency is based on classical theory? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Much of the care provided is based on standard operating procedure. 2. Information from the organization refers to the work done as throughput. 3. There is a well-defined chain of command in the organization. 4. During interviews with staff, the words creativity and flexibility are often used. 5. The facilitys organizational chart reveals departmentalization.

Correct Answer: 1,3,5 Rationale 1: Division of work, specialization, and standardization are valued in the classical theory. Rationale 2: Input, throughput, and output are terms used in systems theory. Rationale 3: The classically organized facility has a well-defined chain of command. Rationale 4: Creativity, flexibility, and fluidity are all prized components of the chaos theory. Rationale 5: Classical theorists developed the concept of departmentalization as a means to maintain control, reinforce authority, and provide a formal system for communication.

The nurse manager has determined that changes are necessary in the way holiday shifts are assigned. When assessing the political climate surrounding this potential change, the nurse manager would ask which questions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Who is in control of the way holiday shifts are being assigned? 2. What communication technology is available to distribute information about the change in holiday shift assignments? 3. Who will lose when holiday shift assignments are changed? 4. Will changing holiday shift assignments affect the budget? 5. Who is benefiting the most from the way holiday shifts are currently assigned?

Correct Answer: 1,3,5 Rationale 1: It is important to identify who is in control of the way things are being done currently. Rationale 2: Communication technology may be helpful in completing the change but is not assessed as part of the political climate surrounding the change. Rationale 3: Early knowledge of who will lose in the change is essential to preparation. Rationale 4: Costs and benefits of the change should be assessed but are not a part of the political climate. Rationale 5: Political climate involves power, benefits, and losses.

A nursing administrator overhears nurses conversing during a break in a seminar on change. The administrator would interpret which statement as meaning that the nurse who made it is ready to become a change agent? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. I know that suggesting this change may backfire on me. 2. I dont expect too much conflict or resistance to this change. 3. I see an opportunity to make a difference in the way this facility provides nursing care. 4. I think the status quo is just fine for now. 5. This change is certainly going to be a challenge, but thats okay.

Correct Answer: 1,3,5 Rationale 1: This statement exemplifies the willingness to take risks that is necessary to become a change agent. Rationale 2: The nurse should always expect that change will be met with resistance and possible conflict. Rationale 3: Nurses should always look for ways to improve client outcomes. Rationale 4: Change occurs when people become uncomfortable with the status quo. Rationale 5: Accepting that change is challenging is part of being a change agent.

A nurse managers supervisor reports that many staff members have complained about the managers rigidity. What situations reflect this rigidity? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The manager has historically used trial and error as a decision-making strategy. 2. The manager takes unnecessary risks when staffing the unit. 3. The manager is not concerned when staff members arrive late to work. 4. The manager uses old ways of thinking to solve the day-to-day issues of the unit. 5. The manager does not consider the advice of the unit comanager when making a decision.

Correct Answer: 1,4 Rationale 1: A history of ineffective trial and error solutions to problems tends to make the manager rigid. Rationale 2: Generally, fear of risk taking is characteristic of a rigid management style. Rationale 3: Rigidity in personality often translates to rigidity in management style. A rigid manager would be upset if staff members routinely came to work late. Rationale 4: Using old ways of thinking to solve new problems is characteristic of rigid management. Rationale 5: Rigid managers typically prefer to make decisions independently.

A nurse manager is faced with the task of introducing an unpopular change to a staff that includes several nurses who have acted as rejecters to previous changes. The manager expects resistance but hopes to identify these rejecters early in the process. The manager should be particularly alert to which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. I dont care what they say; Im not giving care that way. 2. I dont think this is going to work, but Ill probably come around to it sooner or later. 3. Im not crazy about this idea, but we do need to change how we are providing care. 4. I bet I can make it very difficult for this change to occur. 5. It wont be so bad. I like change.

Correct Answer: 1,4 Rationale 1: Rejecters often respond with active opposition. Rationale 2: This statement is characteristic of an early or late majority resister. Rationale 3: Acknowledging that change is necessary is characteristic of an early adopter. Rationale 4: Making the change more difficult is a form of sabotage, which is characteristic of a rejecter. Rationale 5: Innovators love change and thrive on it.

The nurse applying for a position is told, This hospital has a very traditional organizational structure. The nurse would expect the organization to use which structure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Functional 2. Shared governance 3. Service-line 4. Parallel 5. Matrix

Correct Answer: 1,4,5 Rationale 1: A functional structure is a traditional organizational structure. Rationale 2: Shared governance is a new, more relationship-based organizational structure. Rationale 3: A service-line structure is a new, more relationship-based organizational structure. Rationale 4: A parallel structure is a traditional structure, even though it is more modern than a functional structure. Rationale 5: Matrix is a traditional structure.

A staff nurse tells the manager, I dont want to be promoted. I am a much better follower than I am a leader. How should the manager interpret this remark? 1. Leadership takes more energy than followership, so this nurse is taking the easy way out. 2. Followership is a valuable skill in nurses. 3. A nurse who is not willing to work to master the skills of leadership should not be retained on the unit. 4. Most people have difficulty developing leadership skills.

Correct Answer: 2 Rationale 1: Active following takes skill, self-direction, and energy. There is no evidence that it is easier than leading. Rationale 2: In any situation where people must work together, followership is a valuable skill. Rationale 3: There is no indication that this nurse is not effective in the followership role and may be a valuable employee without leadership skills. Rationale 4: Leadership skills can be learned.

The new chairperson of the nursing department has determined that the facultys teaching is stagnant and outmoded. The chairperson would like to encourage the faculty to adopt more innovative teaching strategies. According to Lewin, what is the first step in initiating this plan? 1. Bring an expert on innovative teaching strategies to campus for a meeting with faculty. 2. Include the staff in identifying problems related to teaching strategies. 3. Ask staff to assist in the development of a plan for implementing new teaching strategies. 4. Implement interventions to improve the teaching strategies currently used.

Correct Answer: 2 Rationale 1: Bringing in an expert to talk to the faculty would be ineffective until the faculty is beginning to unfreeze their current beliefs about teaching. Introducing an expert at this time might do more harm than good. Rationale 2: The first step is to unfreeze the existing equilibrium by asking staff to become part of the process of change, particularly in the first phase. Rationale 3: Asking the staff to assist in developing a plan is incorrect because the planning part of the process occurs after the problem areas have been identified. Rationale 4: The faculty will likely not be receptive to new strategies until they have identified a need to change.

Using the classical organizational theory model, what would be the most appropriate method for the nurse to voice concern over unfair client workload assignments? 1. Circulate a petition to all staff seeking support for change in assignment policy and present the signed petition to the nursing supervisor. 2. Discuss the problem with the nurses team leader and then the charge nurse if the problem remains unsolved. 3. Invite the vice president in charge of nursing to a unit meeting. 4. Organize a unit meeting to discuss the problem on all shifts.

Correct Answer: 2 Rationale 1: Circulating a petition among staff does not follow the formal chain of command inherent in classical organizational theory. Rationale 2: In classical theory there is a formal chain of command and system for communication. Discussing the issue with the team leader is the first step in the chain of command. If that strategy is ineffective, the next step is discussing the issue with the charge nurse. Rationale 3: Taking concerns straight to the vice president in charge of nursing does not follow the formal chain of command inherent in classical organizational theory. Rationale 4: Organizing a unit meeting does not follow the formal chain of command inherent in classical organizational theory.

he nursing supervisor identifies ineffective communication as a problem among the managers. According to Lippitts phases of change, which action by the supervisor reflects the final stage of improving this issue? 1. The supervisor uses outcome data to evaluate the amount of change that has occurred. 2. The supervisor has gradually withdrawn from the role of change agent. 3. The supervisor has developed strategies to maintain the change. 4. The supervisor has determined if anyone in the group is sabotaging change efforts

Correct Answer: 2 Rationale 1: Evaluating the amount of change would occur before the final stage. Rationale 2: According to Lippitts phases of change, the final stage is terminating the helping relationship. Rationale 3: Maintaining the change is the next to last of Lippitts stages. Rationale 4: Looking for persons who may be sabotaging change efforts is not the last of Lippitts stages.

A nursing task force has been created to determine whether a new model of differentiated practice would be more effective than the current model. The task force analyzes data as a basis to examine alternatives. Which activity does this represent? 1. Group problem solving 2. Critical thinking 3. Groupthink 4. Satisficing

Correct Answer: 2 Rationale 1: Group problem solving implies that a problem exists, which is not the case in this situation. The task force is comparing two models of practice, not solving a problem. Rationale 2: Critical thinking is a higher-level cognitive process that involves the examination of assumptions, interpretation and analysis of arguments, and the development of a conclusion that can be justified. Rationale 3: Groupthink is a negative phenomenon that occurs in highly cohesive groups that become isolated. There is no evidence that groupthink has occurred in this situation. Rationale 4: Satisficing is a type of decision-making strategy that identifies a strategy that is minimally acceptable. There is no evidence that satisficing has occurred in this situation.

Which structure is reflected by the statement Nursing practice is best determined by nurses? 1. Hybrid 2. Shared governance 3. Matrix 4. Functional

Correct Answer: 2 Rationale 1: Hybrid structure is typical of a growing institution and consists of both self-contained units and functional units. Top administrators still make many of the decisions for the organization. Rationale 2: Shared governance is a form of participative decision making. Nurses gain control over practice, are more accountable, and feel empowered. Rationale 3: Matrix structure combines functional structure and product structure into one overlapping structure. The dual authority created can be frustrating and confusing. Managers and administrators make many of the organizational decisions. Rationale 4: Functional structure is a traditional structure in which employees are grouped in departments by specialty. Most decisions are made by senior managers.

The nurse manager makes an error that results in the unit being $20,000 short on operating budget for the fiscal year. When asked about the error, the nurse takes full responsibility This statement reflects which component of emotional intelligence? 1. Initiative 2. Transparency 3. Empathy 4. Conflict management

Correct Answer: 2 Rationale 1: Initiative is the readiness to act and seize opportunities. Rationale 2: Transparency is displaying honesty and integrity. Rationale 3: Empathy is sensing others emotions and understanding their perspective. Rationale 4: Conflict management is the ability to resolve disagreements.

The health care organizations monthly newsletter has a headline reading Nurse Promoted to Leader of Specialty Care Units. What is the error inherent in this headline? 1. One person cannot be the leader of all the specialty care units in an organization. 2. A person cannot be promoted to the role of leader. 3. Leaders have to be hired from outside the organization. 4. Nurses cannot serve as leaders over other nurses.

Correct Answer: 2 Rationale 1: Leadership is not unit specific. Rationale 2: The organization cannot promote someone to the position of leader. A leader uses interpersonal skills to influence others to accomplish a specific goal. The organization can promote a person who may become a leader. Rationale 3: A leader cannot be hired. Rationale 4: Nurses often develop strong leadership over other health care providers, including other nurses.

Hospital administrators are considering changing from the traditional method of creating work schedules to a system in which the nurses will choose their own workdays. Choices will be made according to seniority. Which change strategy would likely be best for this endeavor? 1. A power-coercive strategy 2. A normative-reeducative strategy 3. An empirical-rational model 4. A driving force

Correct Answer: 2 Rationale 1: Power-coercive strategies are used when much resistance is anticipated, time is short, and the change is critical for organizational survival. This strategy may meet with resistance from the nursing staff. Rationale 2: In most cases, the normative-reeducative approach to change is effective in reducing resistance and stimulating personal and organizational creativity. Rationale 3: The empirical-rational strategies are most often effective when little resistance to the proposed change is expected, and the change is perceived as reasonable. This is likely not the case with the change described. Rationale 4: A driving force is a behavior that facilitates change by pushing participants in the desired direction in spite of restraining forces.

During a performance evaluation the nurse manager states, My span of control is just too large. How should the unit supervisor interpret this statement? 1. The nurse manager is not capable of performing all the duties expected of the role. 2. The nurse manager may have too many staff members to manage. 3. The nurse manager is burned out and needs time away from the unit. 4. The nurse manager is not educationally prepared for the role.

Correct Answer: 2 Rationale 1: Span of control is not directly related to the number of duties expected. Rationale 2: Span of control addresses the number of employees a manager can effectively supervise. Rationale 3: Span of control issues may result in burnout, but there is no indication from this scenario that this is the case. Rationale 4: There is no indication that the nurse managers level of education is insufficient for the role.

The nurse works in a school clinic that is part of an integrated health care network. How would this nurse explain to parents and teachers the focus of care provided in the clinic? 1. Hospital focused 2. Primary care focused 3. Specialty care focused 4. Home care focused

Correct Answer: 2 Rationale 1: The goal of an integrated health care network is to keep clients healthy and out of the hospital. Rationale 2: Primary care is the focus of integrated health care networks. Rationale 3: The goal of an integrated health care network is to keep clients healthy, thereby minimizing the need for specialty care visits. Rationale 4: The goal of an integrated health care system is to keep clients healthy so that more expensive options, like home care, are not needed.

Hospital administration is considering the purchase of a robotic pharmacy system. What would be the advantage of this system to the nurses who work in the hospital? 1. The nurse will be able to leave out some of the six rights of medication administration because the robot checks the medications. 2. The nurse should get medications more quickly because the robot can work more consistently without breaks. 3. The nurse can delegate medication administration to the nursing assistant because the medications have already been checked. 4. The nurse can expect that medication administration will be easier and carry less potential for error.

Correct Answer: 2 Rationale 1: The registered nurse must still to complete the six rights of medication administration to ensure client safety. Rationale 2: Robots should be able to get medications to the floor more quickly. Rationale 3: The administration of medication cannot be delegated to the nursing assistant. Rationale 4: There is no assurance that medication administration will be easier.

Procedural changes are being planned on the unit as a direct result of client satisfaction surveys. Which person is most strategically placed to handle how these changes are initiated? 1. Staff nurse 2. Nurse manager 3. Chief financial officer (CFO) 4. Chief executive officer (CEO)

Correct Answer: 2 Rationale 1: The staff nurse will be instrumental in carrying out the changes but is not the most influential in directing them. Rationale 2: The nurse manager is situated on the front lines but is also responsible to upper management. The manager can be supportive of the staffs feelings while at the same time adequately and appropriately representing the needs and wants of the administration. Rationale 3: The CFO will certainly have some say in the financial support of any changes made but is unlikely to have sufficient knowledge of the day-to-day operations of the unit to handle changes at that level. Rationale 4: The CEO is unlikely to have enough information about the daily unit activities to be effective in instituting these changes.

A 70-year-old client develops a catheter-induced urinary tract infection. Which statement by the nurse would indicate to the nurse manager a need for additional understanding of this situation? 1. I wonder if there was a break of sterility when this catheter was inserted. 2. Thankfully we can treat this with an antibiotic. 3. This could potentially cost the hospital a lot of money. 4. I will talk to my unlicensed assistants about proper urinary catheter care.

Correct Answer: 2 Rationale 1: Wondering about a break in sterility indicates that the nurse is concerned about the process that might have contributed to this infection. Rationale 2: The nurse who focuses on taking care of the results of a potential medical mistake is not accepting the seriousness of the situation. Rationale 3: The Centers for Medicare and Medicaid Services no longer cover the costs incurred by medical mistakes. This urinary tract infection could cost the hospital the cost of treatment, including increased length of stay. Rationale 4: The nurse has identified that improper care may result in poor outcomes for the client. Global Rationale:

The nurse manager asks a staff nurse why a procedure is done in a certain manner. The nurse replies, I dont know why I started doing it this way. Ive never read any research on it, but this technique always works for me. The manager would place this technique into which category of evidence? 1. Case study 2. Anecdotal 3. Nonexperimental design research 4. Statistical

Correct Answer: 2 Rationale 1: A case study is an in-depth analysis used to translate evidence into other clinical situations. Rationale 2: Anecdotal evidence is derived from experience. Rationale 3: Nonexperimental design research includes gathering factors related to a clinical condition. Rationale 4: Statistical evidence is built from a scientific approach.

A nurse manager who is retiring is helping the new manager learn about the position. As part of this education, the current manager has the new manager make all decisions that can be made under certainty. What conditions will these decisions have in common? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. There is risk associated with the decision. 2. The alternatives are known. 3. The conditions of each alternative are clear. 4. Possible consequences of alternatives are not known. 5. The decision is complex and dynamic.

Correct Answer: 2,3 Rationale 1: With decisions made under certainty, there is little if any risk. Rationale 2: When a decision is made under certainty, the possible alternatives are known. Rationale 3: When a decision is made under certainty, the conditions surrounding possible alternatives are clear. Rationale 4: If possible consequences of alternatives are not known, the decision is being made under conditions of uncertainty. Rationale 5: Complex and dynamic decisions are those made under uncertainty.

The nurse is working on a committee tasked with making a major organizational change. Which comments by the nurse would help to advance the work of this committee? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. I would like to focus on completing this process so we can move on. 2. Have we looked at all available data in order to make an informed decision? 3. What are the obstacles to implementing this change within the organization? 4. Are we including the opinions of all stakeholders in this decision? 5. I think it does not really matter when we institute this change, as long as it is over quickly.

Correct Answer: 2,3,4 Rationale 1: Completing the process is not the major focus of the work. Rationale 2: Those involved in change should be certain that sufficient data is present to make an informed decision. Rationale 3: Persons working on this committee should be aware of obstacles they may face. Rationale 4: It is important to consider the opinions of the organizations stakeholders. Rationale 5: Getting the change instituted quickly is not the focus of committee work.

The nurse manager is conducting a nurses annual performance review. Which events from the previous year would be evidence that this nurse is a successful follower? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse attended over 80 percent of staff meetings but offered little input into discussion. 2. The nurse participated in testing a new charting system before it was installed on the unit. 3. In a private meeting with the nurse manager, the nurse critiqued the managers decision to change the units method of client assignment. 4. After attending an in-service presentation on a new intravenous access catheter, the nurse used one of the devices the next time an IV was ordered. 5. When asked for an opinion on an issue dividing the unit, the nurse replies, I dont know. What do you think?

Correct Answer: 2,3,4 Rationale 1: Merely attending staff meetings is not a sign of good followership. Rationale 2: Active, positive participation shows good followership. Rationale 3: As long as the critique is private, this demonstrates that the nurse is engaged and thinking about the processes. Rationale 4: Taking the initiative to try out changes is considered good followership. Rationale 5: This is an example of dependent thinking, which is not good followership.

Which health care situations reflect the philosophy of quality management as designed by Deming? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A nurse asks visitors to leave because it is after visiting hours. 2. At 2:00 p.m. the nurse orders a lunch tray for a client who has just been removed from NPO status. 3. A nurse tells the manager that a housekeepers work is not up to standards. 4. A nurse volunteers to take a Spanish language class to be able to communicate with clients. 5. A nurse who has not made a medication error in two years asks for a salary increase.

Correct Answer: 2,3,4 Rationale 1: The philosophy of quality management is focus on the needs of the consumer. If there is no reason for the visitors to leave other than it after visiting hours, this is not focused on client need. Rationale 2: Even though 2:00 p.m. is after lunchtime, this nurse is focused on the clients needs. This is an example of quality management. Rationale 3: Quality management empowers the employee to evaluate quality. Rationale 4: This nurse has seen a need and is working to improve the quality of service. This is quality management. Rationale 5: Salary increases can be tied to quality improvement initiatives, but just asking for an increase is not quality management.

The staff is transitioning to a major change in the provision of nursing care in a large hospital. Which behaviors should the nurse manager watch for that would indicate possible problems? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Nurses are discussing the change at breaks and meals. 2. Nurses are doing both the old work and the new work. 3. A nurse says, I guess everything weve done for years is wrong. 4. The provision of care with the new system takes longer than expected. 5. Nurses are doing parts of the old procedure and parts of the new procedure.

Correct Answer: 2,3,5 Rationale 1: It is natural that the staff would discuss the change and its implications. Rationale 2: Adding the new work to the old work is a sign that the transition is not healthy. Rationale 3: This attitude is a sign that the transition is not healthy. Rationale 4: It is natural for the transition to a new process to take time. The nurse manager should be on the alert if this continues. Rationale 5: Making individual decisions about what parts of the old method to retain and what parts of the new method to adopt is a sign that the transition is not healthy.

A client who was discharged yesterday is very upset about the quality of care received during hospitalization for gastric surgery. What options for reporting concerns does this client have? Standard Text: Select all that apply. 1. There is no mechanism for complaint as the client is no longer hospitalized. 2. The client can indicate dissatisfaction on the survey often sent to clients after discharge. 3. The client can call the hospital administration. 4. The client can make a formal complaint through the American Nursing Association. 5. The client can make a public report through the Agency for Healthcare Research and Quality.

Correct Answer: 2,3,5 Rationale 1: The client can still voice concerns even after discharge. Rationale 2: These client satisfaction surveys are a good mechanism for discussing care issues. Rationale 3: Telephone calls are a means of discussing client care issues. Rationale 4: ANA is not a forum for complaints about care in a specific hospitalization. Rationale 5: The Agency for Healthcare Research and Quality has a mechanism for reporting care issues.

Staff nurses have been asked to comment on the work of a nurse manager as part of the managers performance review. Which comments by the staff nurses would indicate to the supervisor that the manager is also a leader? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. He helped me to understand the structure of the hospitals organization. 2. I hope to be as good a manager as he is someday. 3. He negotiated a pay increase for the RNs on the unit. 4. His example has encouraged me to get to know people in other departments in the hospital. 5. His assignments are always fair and appropriate for the client census.

Correct Answer: 2,4 Rationale 1: Clarification of organizational structure is part of the managers job. Rationale 2: A leader uses interpersonal skills to influence others to accomplish a specific goal. Rationale 3: Negotiating pay is a role of the manager. Rationale 4: Leaders help to forge links among the organizations members. Rationale 5: Making assignments is a part of the managers role.

Although the postoperative assessment of a client reveals no abnormalities, the nurse believes the clients condition is deteriorating and orders frequent vital signs. This intervention was made on the basis of which type of problem solving? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Experimentation 2. Intuition 3. Satisficing 4. Past experience 5. Trial-and-error method

Correct Answer: 2,4 Rationale 1: Experimentation involves testing a theory to produce a prediction. Rationale 2: Intuition and past experiences enable the expert nurse to make clinical judgments based on wisdom, sensitivity to the client, and a gut feeling that a change in the client is imminent. Rationale 3: Satisficing involves choosing a solution to meet minimum standards of care. Rationale 4: Intuition and past experience enable the expert nurse to make clinical judgments based on wisdom, sensitivity to the client, and a gut feeling that a change in the client is imminent. Rationale 5: The trial-and-error method is not based on prior experience; rather, one approach after another is tried until the problem is solved.

The nurse manager has been assigned the task of developing and implementing a new staffing system for the emergency department. The nurse has reached the directing phase of this project. On which activities would the nurse focus at this point? 1. Deciding on the skill mix necessary for direct client care 2. Selling the new system to the current emergency department staff 3. Comparing the actual results of the new system to the projected results 4. Telling staff what to do 5. Coaching the staff through the implementation of a new schedule

Correct Answer: 2,5 Rationale 1: Deciding on the skill mix would be part of organizing the project. Rationale 2: Convincing or selling the new idea is part of the directing phase. Rationale 3: This comparison is part of the controlling phase. Rationale 4: In todays environment the directing phase consists of guidance rather than telling the staff what to do. Rationale 5: Coaching and counseling are two major roles in the directing phase.

In a leadership training class, which statement by a student indicates learning has been successful? 1. If I am to be successful in leadership, I should make sure no followers are friends. 2. Most people would not be able to tell if I only pretend to be interested in them. 3. Relationship building is essential to successful leadership. 4. Leadership means I can delegate tasks I do not want to do.

Correct Answer: 3 Rationale 1: Although the leader can show no favoritism, leaders can have friends among the group of followers. Rationale 2: The caring demonstrated in the leadershipfollowership relationship must be authentic. Rationale 3: Authentic caring in relationships is an important method of improving respect and competence as a leader. Rationale 4: Authentic leaders are willing to take risks and are not afraid to do any task.

A community-owned hospital has been purchased by a health care conglomerate. The staff is aware that the organizational theory governing the hospital is likely to change. Which statement indicates a lack of understanding of organizational theory on the part of a staff nurse? 1. If our new bosses want a classical organization, we can expect a strong hierarchy. 2. If we dont want to see lots of changes, we should hope our new bosses dont like chaos theory. 3. If this new company is based on systems theory, there will be a lot of focus on how much work we can produce. 4. If this new company is based on contingency theory, we will see lots of focus on how our environment impacts our work.

Correct Answer: 3 Rationale 1: Classical organizational theory focuses on structure with a strong hierarchy. Rationale 2: Those who support chaos theory believe that organizational function and integrity must be guided by flexibility, fluidity, speedy adaptability, and cultural sensitivity. Change is inevitable and embraced. Rationale 3: Systems theory focuses on input or resources, throughput or the work done, and output or the product of the work. Rationale 4: Contingency theory posits that organization performance can be enhanced by matching an organizations structure to its environment.

A successful nurse manager is mentoring a newly promoted nurse manager. Which comment by the mentor reflects the most important consideration of all nurse managers? 1. You must work to develop your staffs competencies. 2. Take your role on the strategic planning committee very seriously. 3. Your most important role is to ensure client care accountability. 4. Fiscal resource management is the most important aspect of your job.

Correct Answer: 3 Rationale 1: Developing staff competencies is very important but not the most important consideration. Rationale 2: Strategic planning is very important but not the most important consideration. Rationale 3: Although the nurse manager has a variety of roles and tasks, the most important role is assuring quality client care. The nurse manager is accountable for quality care. Rationale 4: Managing fiscal resources is a very important task of the nurse manager but not the important consideration.

A nurse has been invited to discuss health care costs at a senior citizens club. What information should the nurse plan to include in this discussion? 1. While health care costs continue to rise, the percentage of the U.S. economy spent on health care has slowly declined to less than 12%. 2. Regulations brought about by the Patient Protection and Affordable Care Act (PPACA) should bring financial relief to health care consumers. 3. The United States spends more money on health care than any other country. 4. Health care spending in the United States is slowly declining due to passage of bills such as the Patient Protection and Affordable Care Act (PPACA).

Correct Answer: 3 Rationale 1: In 2009, health care costs consumed over 17% of the countrys gross domestic product. Rationale 2: Implementation of PPACA and its regulations have not been formulated. Rationale 3: The United States spends over $2.5 trillion on health care annually, more than any other country. Rationale 4: While this act has been passed, it is not operationalized. Health care spending continues to rise.

Question 14 Type: MCSA The CEO of the hospital approaches the chief nurse with a request that the nurse act as the primary change agent in the implementation of a new hospital-wide policy. Why would the nurse be a good choice for this assignment? 1. Nurses thrive on transition and work best in such circumstances. 2. Nurses are role models for reacting positively to change. 3. Nurses routinely interact with multiple disciplines. 4. Nurses are always acting in the clients best interest.

Correct Answer: 3 Rationale 1: It is hard to prove that nurses thrive on transition. Rationale 2: Nurses have not always reacted positively to change. Rationale 3: Nurses are client advocates who routinely interact with multiple disciplines in the provision of quality care. Rationale 4: Nurses do act in the clients best interest, but this option is not as strong as another.

A newly promoted nurse manager would like staff to solve problems without relying on preconceived ideas. How should the manager role-model this ability? 1. When disagreements occur on the unit, the manager privately asks the dissenters to be silent about the issue at meetings. 2. Tell staff members that they must present one opinion regarding the solutions they desire. 3. Demonstrate a genuine desire to find our why there is dissention. 4. Develop tunnel vision when it comes to problems on the unit.

Correct Answer: 3 Rationale 1: Managers should not assume that only one opinion can be voiced and that others will be silent. Rationale 2: Managers should not assume that only one opinion can be voiced. Rationale 3: Good managers start out with a commitment to find out why others disagree. Rationale 4: Tunnel vision makes it difficult to see things from another perspective and will not encourage staff to avoid preconceived ideas.

Computerized charting will be initiated on select units of the hospital. Orientation to this new system will be provided to each nurse by a team of nurses educated in nursing informatics. This is an example of which type of change strategy? 1. Normative-reeducative strategies 2. Lippitts phases 3. Empirical-rational model 4. Power-coercive strategies

Correct Answer: 3 Rationale 1: Normative-reeducative strategies focus on peoples roles and relationships, perceptual orientations, and attitudes that influence their acceptance of change. Rationale 2: Lippitts phases of change are a seven-step process of change that involves participants in every step of the process. Rationale 3: The assumption of the empirical-rational model is that people are rational and will follow their rational self-interest if that self-interest is made clear to them. In this instance, when the nurses have the knowledge to use the charting system and have a chance to try it, it will become clear that it is in their best interest to adopt the new system. Rationale 4: Power-coercive strategies are based on the application of power by legitimate authority, economic sanctions, or political influence.

The nurse manager is facing resistance to change from many staff nurses. Why should the manager work hard to address this resistance? 1. Resistance will keep the change from occurring at all. 2. Resistance from the late majority can keep others from accepting the change. 3. Resistance can negatively impact future client care. 4. Resistance allows others to take power from managers.

Correct Answer: 3 Rationale 1: Resistance generally does not completely prevent change, but it may stall or delay it. Rationale 2: The late majority eventually does accept the change. Rationale 3: Client care is always the most important reason that nurses do what they do. If the change does not improve client care in some respect, is it worth the effort? If resisters interrupt the work of the unit or refuse to provide care as directed by the change, the quality of care may suffer. Rationale 4: Resistance is a normal part of change and does not mean that power has been diverted to the resisters.

Which action by the nurse manager is a demonstration of satisficing? 1. The nurse manager works with the staffing schedule until all requested days off are honored. 2. The nurse manager reposts a job opening because no applicants were a good fit for the current unit staff. 3. The nurse manager agrees with a proposed budget that does not provide badly needed new client beds. 4. The nurse manager insists on firing a nurse who is chronically late to work.

Correct Answer: 3 Rationale 1: Satisficing would not involve extra effort to honor requested days off. Rationale 2: If the nurse manager was satisficing, someone would be hired, even if the fit was not good. Rationale 3: This is an example of satisficing. An example of not satisficing would be the nurse manager not agreeing with the budget until funding for the beds was provided. Rationale 4: A nurse manager who is satisficing would provide continued counseling, work with the nurse, make excuses, and retain the nurse on staff.

The nurses friend says, Ive been thinking about going to that health care clinic in the grocery store so someone can look at my daughters rash. What do you think? Which response by the nurse is appropriate? 1. Most of those retail clinics are not very good. Id go somewhere else. 2. That would be okay, but you have to pay extra for the convenience. 3. If the nurse practitioner at the clinic thinks the rash is significant, you will be referred for additional care. 4. I would use the clinic for myself, but not for my children.

Correct Answer: 3 Rationale 1: Studies on the quality of care provided by these clinics have shown it to be comparable to care provided elsewhere. Rationale 2: Most retail clinics are less expensive than physician offices or emergency departments. Rationale 3: Care in these clinics is provided by nurse practitioners with physician backup. If the nurse practitioner believes additional studies or assessment should be done, referrals are made. Rationale 4: There is no indication that the clinic is not appropriate for children.

The nurse manager knows that maximum power will be needed to achieve a desired change and has identified a key person on the organizational chart who will be affected by the change. What is important for the nurse manager to do? 1. Try to minimize the impact of the change when talking to this person. 2. Bypass this person and talk to the administrator who supervises him or her. 3. Pay attention to the people above and below this person on the organizational chart. 4. Try to find some information against this person to use as leverage.

Correct Answer: 3 Rationale 1: The nurse manager should always be honest when discussing the change. Rationale 2: The nurse manager should not jump the chain of command to speak to this persons supervisor. Rationale 3: The people just above and just below this person will be important to the way this key player reacts to the change. Rationale 4: This tactic would not be ethical.

The nurse manager generally uses a stepwise method to arrive at decisions that are logical and that serve to maximize the achievement of the desired objective. Which decision-making model does this manager use? 1. Political decision-making model 2. Experimentation process 3. Rational decision-making model 4. Trial-and-error method

Correct Answer: 3 Rationale 1: The premise of the political decision-making model is that decisions align with the interests of powerful stakeholders such as hospital boards and regulatory bodies. Rationale 2: Experimentation involves the use of a pilot project to test the effectiveness of a solution. Rationale 3: The rational decision-making model is a series of steps that managers take to make logical, rational choices that maximize the achievement of successful outcomes. Rationale 4: The trial-and-error method is used by inexperienced managers and involves the application of one solution after another to improve a problem.

Hospital administration is working with a university school of nursing to establish a nursing residency program. Why is this a desired action? 1. A residency program eliminates the hospitals liability if a novice nurse makes an error. 2. A residency program is established to make nursing education more like physician education. 3. The Institute of Medicine has proposed residency programs for nurses. 4. A residency program ensures that nurses participate in lifelong learning.

Correct Answer: 3 Rationale 1: There is no reduction of the hospitals liability for errors. Rationale 2: Residency programs for nurses are not being established to mimic physician education. Rationale 3: The IOM has made this proposal. Rationale 4: There is no assurance that nurses who participate in residency programs will engage in lifelong learning.

A newly licensed nurse received specific knowledge of management skills while in nursing school. What does the nurse need now? 1. Nothing until the nurse has acquired enough bedside experience to become a manager 2. Time to see how these skills will be needed in the future 3. A manager who can help with skills transfer from school to work 4. A job working as a manager in a small hospital

Correct Answer: 3 Rationale 1: All nurses are managers. Rationale 2: The nurse will use these skills on the first job. Rationale 3: The manager is an essential component in helping the new nurse transfer this learning into the real world of bedside care. Rationale 4: The newly licensed nurse does not have the skill set and experience to work as a manager.

Question 26 Type: MCMA Which leadership activities exemplify a quantum leadership style? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The leader reports how outcomes were achieved. 2. The leader brings cookies and coffee to every early morning meeting. 3. The leader is accepting of change. 4. The leader encourages staff nurses to help clients access Internet sites about their disease process. 5. The leader often talks about the vision of the organization.

Correct Answer: 3,4 Rationale 1: In quantum leadership, the outcome is more important than how it was achieved. Rationale 2: This social emphasis is more likely to occur with a leader who is transactional. Rationale 3: Change is expected by the quantum leader. Rationale 4: Informational power is shared by the quantum leader. Rationale 5: Focus on vision is an attribute of a transformational leader.

A nurse manager is directing a team of staff nurses working to solve a clinical problem using evidence-based practice (EBP). Which manager statements would direct these nurses to the forms of strongest clinical evidence? Standard Text: Select all that apply. 1. We may find studies that use only one group of subjects. 2. Look for articles that report on how to use evidence in other clinical situations. 3. The studies we want are built around the scientific approach to solving problems. 4. Our focus should be on studies that use both experimental and control groups to determine intervention effectiveness. 5. Many articles will have information reported by someone who is an expert in the field.

Correct Answer: 3,4 Rationale 1: Studies using only one group of subjects are done in a quasi-experimental design. This is not one of the two strongest forms of evidence. Rationale 2: An in-depth analysis used to translate information to other clinical situations is a case study approach. This is not one of the two strongest forms of evidence. Rationale 3: Using the scientific approach results in statistical evidence, which is one of the two strongest forms. Rationale 4: Studies that use both experimental and control groups are randomized control trials. This is one of the two strongest forms of evidence. Rationale 5: Evidence reported by an expert in the field is testimonial evidence. It is not one of the two strongest forms of evidence.

Which statement by the formal leader of a nursing unit reflects the personality required to energize the staff and promote creativity? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. I would like to change the format we use for shift report, but Im afraid it would upset staff members who have been here a long time. 2. This is the decision I have made, and there is no room for discussion. 3. I would like to thank everyone for your hard work and dedication while we have been short staffed. 4. I am certain that our new assignment system is going to make the workload more equitable. 5. I know this week has been rough. I feel a little like sandpaper myself.

Correct Answer: 3,4,5 Rationale 1: Basing decisions on placating staff indicates the leader is insecure and does not energize staff or promote creativity. Rationale 2: The leader who does not value input from staff will not promote creativity. Rationale 3: The leader who recognizes the staffs efforts and sacrifices is more likely to energize the staff. Rationale 4: Optimism is crucial to energizing staff and promoting creativity. Rationale 5: Humor is a good method to help energize staff and promote creativity.

A health care organization is using the quality concepts of lean thinking and decentralization as part of their redesign efforts. Which initiatives would this organization undertake? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Any changes to processes in the facility will be approved at the vice president level. 2. Nurses who have made over five medication errors in the last 12 months will be terminated. 3. Outcome data will be analyzed to identify successful interventions. 4. The primary focus will be on a few major initiatives. 5. Previous quality improvement efforts may or may not be discarded.

Correct Answer: 3,5 Rationale 1: Decentralization empowers staff to implement process improvements. Rationale 2: Lean thinking focuses on the system rather than on individuals. Rationale 3: In lean thinking, the concentration is on interventions that improve outcomes. Rationale 4: This redesign strategy is called big-dot focus and may or may not reflect lean thinking. Rationale 5: Decentralization provides a quality improvement infrastructure that disregards only previous efforts that have not proven effective.

A community hospital has been purchased by a large health care conglomerate. Nursing administration has the task of changing the nursing practice model that has been followed for 50 years. To best achieve this change, administration should appoint a nurse executive whose leadership style follows which theory? 1. Contingency theory 2. Quantum leadership 3. Transactional leadership 4. Transformational leadership

Correct Answer: 4 Rationale 1: According to contingency theory, the manager adapts leadership styles in relation to changing situations; these styles range from authoritarian to permissive. This is not the best choice for this situation. Rationale 2: Quantum leadership focuses on outcomes, and employees are directly involved in decision making. This is not the best choice for this situation. Rationale 3: Transactional leadership is based on the premise that individuals engage in social interactions expecting to give and receive rewards. This is not the best choice for this situation. Rationale 4: Transformational leadership is concerned not with the status quo but with effecting revolutionary change in organizations and human service.

Which factor best represents a driving force in the process of change? 1. An ineffective nurse manager 2. An administration composed of long-term employees 3. A staff composed of long-term employees 4. A financial deficit of millions of dollars

Correct Answer: 4 Rationale 1: An ineffective nurse manager is a restraining force that impedes change by discouraging participants from making specified changes. Rationale 2: An administration of long-term employees can be a restraining force that impedes change by discouraging participants from making specified changes. Rationale 3: A staff of long-term employees can be a restraining force that impedes change by discouraging participants from making specified changes. Rationale 4: A budget in the red necessitates change and pushes participants in the desired direction.

Which situation is an example of organizational culture? 1. Every Friday the administrator allows everyone to wear crazy hats while on the units. 2. The cafeteria opens at 7:00 a.m. for breakfast, 11:00 a.m. for lunch, and 5:00 p.m. for dinner. 3. The administration has set the time clock to count staff late if clocking in 7 minutes after the shift starts. 4. ICU nurses know to take turns covering each others clients to facilitate eating breakfast and lunch on the day shift.

Correct Answer: 4 Rationale 1: As this is a systemwide condition initiated by the administrator, it is an example of organizational environment. Rationale 2: These are set rules published for everyone, including visitors, and make up part of the organizational environment. Rationale 3: This is a systemwide rule established by administration and is part of the organizational environment. Rationale 4: The nurses have created this system of coverage informally as part of their daily work. This is an example of organizational culture and may vary from unit to unit.

Question 28 Type: MCSA The nurse has set a goal of becoming a clinical nurse leader (CNL). What actions should this nurse plan to reach this goal? 1. Obtain experience as a nurse manager. 2. Learn as much as possible about the hospitals organization. 3. Take a class in hospital administration. 4. Return to school to obtain a masters degree.

Correct Answer: 4 Rationale 1: Experience as a nurse manager is not essential to the CNL role. Rationale 2: The CNL role is a unit-based role. Rationale 3: The CNL role is to coordinate care at the bedside and supervise the health care team. Rationale 4: CNLs are educated at the masters level.

A client who is being discharged from the hospital will need follow-up for wound care. The clients spouse is not capable of providing bed baths for the client. The nurse case manager who is planning care for this client should contact which agency? 1. Long-term-care facility 2. Public health department 3. Temporary service agency 4. Home health agency

Correct Answer: 4 Rationale 1: Long-term-care facilities are used for rehabilitation and care needed for extended periods. There is no evidence that this client will be unable to care for self after recovery. Rationale 2: The public health departments focus is usually community health, not individual primary care. Rationale 3: Temporary service agencies are used to provide health care organizations with professional and nonprofessional personnel when the latter are short staffed. Rationale 4: With shorter hospital stays, home health agencies are frequently used to provide clients with intermittent or temporary follow-up care such as wound care and bathing.

The mother of a staff nurse is critically ill and the nurse must miss several shifts of work. If the leadership style of the nursing manager is transactional, which approach to covering these shifts is most likely? 1. I have made out a schedule of who will work to cover these shifts. 2. I can work an extra shift tomorrow night. Who can cover tonight? 3. How can we work together to cover these shifts to help our coworker? 4. If you work overtime tonight I will authorize double your hourly pay rate.

Correct Answer: 4 Rationale 1: Making out a schedule with no input from nursing is authoritative leadership. Rationale 2: Transformational leaders appeal to individuals better selves rather than their self-interests. Rationale 3: Transformational leaders appeal to individuals better selves rather than their self-interests. Rationale 4: Transactional leadership is based on the principles of social exchange theory. The primary premise is that individuals act in their own best interest.

Which statement explains why nurses must be leaders to be successful in client care? 1. You have to be a leader if you want physicians to respect you and the work you do. 2. To function effectively in managed care, you have to be a good leader. 3. Leadership skills will help you be assertive when you give orders to staff and clients. 4. To direct client care activities and get the outcomes you desire, you need good leadership skills.

Correct Answer: 4 Rationale 1: Nurses do not have to be leaders to gain physicians respect. Rationale 2: Leadership skills are helpful, but are not essential, to working in managed care. Rationale 3: Nurses do not give orders to staff and clients. Rationale 4: Nurses must direct client care in order to successfully achieve client outcomes in a timely fashion.

An accreditation visitor observes the following situations in a health care organization. Which situation would this visitor interpret and document as evidence of the shared governance type of shared leadership? 1. Nurses working in groups and managing themselves 2. Nursing leadership originating from a desire to serve and share 3. Two nurses sharing the management role 4. Nurses formally organized to make decisions regarding practice standards

Correct Answer: 4 Rationale 1: Nurses working in groups managing themselves are an example of self-directed work teams rather than shared governance. Rationale 2: Servant leadership arises from a desire to serve and share. This leadership may or may not be shared. Rationale 3: Two nurses sharing the management role are an example of co-leadership. Rationale 4: Shared governance is a formal process. Decision making is done by designated nurse representatives.

Question 18 Type: MCSA The nurse manager is calculating the cost of offering two bonus incentives to nursing staff for covering call-ins for sickness. After reviewing the statistics, the manager finds that option A is more cost-effective than option B but decides to implement option B because it seems safer. Which option best describes the basis of this decision? 1. Probability 2. Probability analysis 3. Objective probability 4. Subjective probability

Correct Answer: 4 Rationale 1: Probability is the likelihood, expressed as a percentage, that an event will or will not occur. Rationale 2: Probability analysis is a method of calculating expected risk; this is the method the nurse used to compare the two options. Rationale 3: Objective probability is the likelihood that an event will or will not occur, based on facts and reliable information. Rationale 4: Even though option A is more cost-effective, the manager believes option B to be in the best interest of the unit. Subjective probability is the likelihood that an event will or will not occur based on personal judgment and beliefs.

The novice nurse manager is acting in the role of change agent for the unit. Which statement indicates that this manager needs further training in regard to change? 1. I must not get so bogged down in details that I lose focus on the ultimate goal. 2. As we go through this process, I think I need to be flexible but persistent. 3. Those who are resistant will probably accept it sooner or later with my support. 4. I think the implementation will go much better if I stay available the whole time.

Correct Answer: 4 Rationale 1: The ability to retain a big-picture focus while dealing with each part of the change is a desirable trait for a change agent. Rationale 2: The change agent must have sufficient flexibility to modify ideas when this will improve the change, but enough persistence to resist nonproductive tampering with the planned change. Rationale 3: It is likely that those who are resistant will adapt to the change if given enough time and support. Rationale 4: Staying available the whole time is not realistic and will make it difficult for the change agent to maintain the energy it will take to make the change more successful.

Which relationship is an example of staff authority in classical theory? 1. The shift supervisor directs the staff nurse to help another nurse admit two new clients. 2. The unit manager asks the staff nurse to participate in a unit conference. 3. The team leader asks the staff nurse to assume care of an extra client after another nurse goes home ill. 4. The staff nurses mentor calls to see how the nurses first day on a new unit progressed.

Correct Answer: 4 Rationale 1: The staff nurse/shift supervisor is an example of line authority. The shift supervisor is responsible for the work of the staff nurse. Rationale 2: The staff nurse/unit manager relationship is an example of line authority. The unit manager is responsible for the work of the staff nurse. Rationale 3: The staff nurse/team leader relationship is an example of line authority. The team leader is responsible for the work of the staff nurse. Rationale 4: The staff nurse/mentor relationship is one in which the mentor offers advice and recommendations to the staff nurse but is not responsible for the care the nurse provides.

Question 16 Type: MCSA The nurse has determined that in order to provide the highest quality care it is important to become more creative. What is the most effective way for the nurse to increase creativity? 1. Watch others implement creative solutions. 2. Work with a group to implement a creative solution. 3. Evaluate the effectiveness of creative solutions. 4. Practice the steps of the process as often as possible.

Correct Answer: 4 Rationale 1: Watching others implement creative solutions would be helpful in improving the nurses creativity, but it is not the best of these choices. Rationale 2: Working with a group to implement a creative solution would be helpful in improving the nurses creativity, but it is not the best of these choices. Rationale 3: Evaluating the effectiveness of creative solutions would be helpful in improving the nurses creativity, but it is not the best of these choices. Rationale 4: The most effective of these methods would be practicing the steps. Creativity is a skill that can be learned and improved through practice, just like technical skills.

As a part of the strategic planning process, nursing units have been asked to develop strategies to meet designated objectives. Which statements represent strategies? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Decrease the amount of time from client admission to the room to completion of the admission assessment. 2. Increase client satisfaction survey scores regarding meals. 3. Decrease the number of medication errors on the unit. 4. Initiate intravenous therapy within 30 minutes of the order being taken. 5. Use scanning mechanisms to record the numbers of supplies used.

Correct Answer: 4,5 Rationale 1: Decreasing the time from admission to assessment is an objective. There is no indication of how this is to be accomplished. Rationale 2: Increasing client satisfaction with better meals is an objective. There is no indication of how this would be accomplished. Rationale 3: Decreasing the number of medication errors is an objective. There are no strategies given for how this would be accomplished. Rationale 4: Initiating IV therapy within a specific time is a strategy. It is specific to the task and specifies an action to take. Rationale 5: Using scanning mechanisms is an example of how something would be done, so it is a strategy.

The nurse is trying to understand why it has taken so long for electronic health records (EHRs) to be used in health care. Which statement is a reason for this delay? 1. Medical-records professionals do not like these records. 2. The use of these records is more expensive than the use of paper records. 3. There have been concerns about privacy and confidentiality. 4. The transition to EHRs is time consuming and tedious.

Rationale 1: The preference of medical records professionals is not the reason these records have had a slow adoption. Rationale 2: The cost of the records is not a primary reason they have had slow adoption. Rationale 3: The most overwhelming issue in using these records has been the professions and publics concerns regarding privacy and confidentiality. Rationale 4: The transition time to EHRs is not the primary reason they have seen a slow adoption.

A health care system is considering applying to the Magnet Recognition Program. The leaders of this health system should prepare to address ________ qualities or Forces of Magnetism.

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